Methicillin-resistant Staphylococcus aureus in Finland: recent changes in the epidemiology, long-term facility aspects, and phenotypic and molecular detection of isolates

Staphylococcus aureus is one of the most important bacteria that cause disease in humans, and methicillin-resistant S. aureus (MRSA) has become the most commonly identified antibiotic-resistant pathogen in many parts of the world. MRSA rates have been stable for many years in the Nordic countries and the Netherlands with a low MRSA prevalence in Europe, but in the recent decades, MRSA rates have increased in those low-prevalence countries as well. MRSA has been established as a major hospital pathogen, but has also been found increasingly in long-term facilities (LTF) and in communities of persons with no connections to the health-care setting. In Finland, the annual number of MRSA isolates reported to the National Infectious Disease Register (NIDR) has constantly increased, especially outside the Helsinki metropolitan area. Molecular typing has revealed numerous outbreak strains of MRSA, some of which have previously been associated with community acquisition. In this work, data on MRSA cases notified to the NIDR and on MRSA strain types identified with pulsed-field gel electrophoresis (PFGE), multilocus sequence typing (MLST), and staphylococcal cassette chromosome mec (SCCmec) typing at the National Reference Laboratory (NRL) in Finland from 1997 to 2004 were analyzed. An increasing trend in MRSA incidence in Finland from 1997 to 2004 was shown. In addition, non-multi-drug resistant (NMDR) MRSA isolates, especially those resistant only to methicillin/oxacillin, showed an emerging trend. The predominant MRSA strains changed over time and place, but two internationally spread epidemic strains of MRSA, FIN-16 and FIN-21, were related to the increase detected most recently. Those strains were also one cause of the strikingly increasing invasive MRSA findings. The rise of MRSA strains with SCCmec types IV or V, possible community-acquired MRSA was also detected. With questionnaires, the diagnostic methods used for MRSA identification in Finnish microbiology laboratories and the number of MRSA screening specimens studied were reviewed. Surveys, which focused on the MRSA situation in long-term facilities in 2001 and on the background information of MRSA-positive persons in 2001-2003, were also carried out. The rates of MRSA and screening practices varied widely across geographic regions. Part of the NMDR MRSA strains could remain undetected in some laboratories because of insufficient diagnostic techniques used. The increasing proportion of elderly population carrying MRSA suggests that MRSA is an emerging problem in Finnish long-term facilities. Among the patients, 50% of the specimens were taken on a clinical basis, 43% on a screening basis after exposure to MRSA, 3% on a screening basis because of hospital contact abroad, and 4% for other reasons. In response to an outbreak of MRSA possessing a new genotype that occurred in a health care ward and in an associated nursing home of a small municipality in Northern Finland in autumn 2003, a point-prevalence survey was performed six months later. In the same study, the molecular epidemiology of MRSA and methicillin-sensitive S. aureus (MSSA) strains were also assessed, the results to the national strain collection compared, and the difficulties of MRSA screening with low-level oxacillin-resistant isolates encountered. The original MRSA outbreak in LTF, which consisted of isolates possessing a nationally new PFGE profile (FIN-22) and internationally rare MLST type (ST-27), was confined. Another previously unrecognized MRSA strain was found with additional screening, possibly indicating that current routine MRSA screening methods may be insufficiently sensitive for strains possessing low-level oxacillin resistance. Most of the MSSA strains found were genotypically related to the epidemic MRSA strains, but only a few of them had received the SCCmec element, and all those strains possessed the new SCCmec type V. In the second largest nursing home in Finland, the colonization of S. aureus and MRSA, and the role of screening sites along with broth enrichment culture on the sensitivity to detect S. aureus were studied. Combining the use of enrichment broth and perineal swabbing, in addition to nostrils and skin lesions swabbing, may be an alternative for throat swabs in the nursing home setting, especially when residents are uncooperative. Finally, in order to evaluate adequate phenotypic and genotypic methods needed for reliable laboratory diagnostics of MRSA, oxacillin disk diffusion and MIC tests to the cefoxitin disk diffusion method at both +35°C and +30°C, both with or without an addition of sodium chloride (NaCl) to the Müller Hinton test medium, and in-house PCR to two commercial molecular methods (the GenoType® MRSA test and the EVIGENETM MRSA Detection test) with different bacterial species in addition to S. aureus were compared. The cefoxitin disk diffusion method was superior to that of oxacillin disk diffusion and to the MIC tests in predicting mecA-mediated resistance in S. aureus when incubating at +35°C with or without the addition of NaCl to the test medium. Both the Geno Type® MRSA and EVIGENETM MRSA Detection tests are usable, accurate, cost-effective, and sufficiently fast methods for rapid MRSA confirmation from a pure culture.

Molecular methods for the epidemiological analysis of methicillin-resistant Staphylococcus aureus (MRSA) and Streptococcus pneumoniae

Methicillin-resistant Staphylococcus aureus (MRSA) and Streptococcus pneumoniae are major health problems worldwide, both found in symptomless carriage but also causing even life-threatening infections. The aim of this thesis was to characterise MRSA and S. pneumoniae in detail by using several molecular typing methods for various epidemiological purposes: clonality analysis, epidemiological surveillance, outbreak investigation, and virulence factor analysis. The characteristics of MRSA isolates from the strain collection of the Finnish National Infectious Disease Register (NIDR) and pneumococcal isolates collected from military recruits and children with acute otitis media (AOM) were analysed using various typing techniques. Antimicrobial susceptibility testing, pulsed-field gel electrophoresis (PFGE), multilocus sequence typing (MLST), spa typing, staphylococcal cassette chromosome mec (SCCmec) typing, and the detection of Panton-Valentine leukocidin (PVL) genes were performed for MRSA isolates. Pneumococcal isolates were analysed using antimicrobial susceptibility testing, serotyping, MLST, and by detecting pilus islet 1 (PI-1) and 2 (PI-2) genes. Several international community- and hospital-associated MRSA clones were recognised in Finland. The genetic diversity among MRSA FIN-4 isolates and among FIN-16 isolates was low. Overall, MRSA blood isolates from 1997 to 2006 were genetically diverse. spa typing was found to be a highly discriminatory, rapid and accurate typing method and it also qualifies as the primary typing method in countries with a long history of PFGE-based MRSA strain nomenclature. However, additional typing by another method, e.g. PFGE, is needed in certain situations to be able to provide adequate discrimination for epidemiological surveillance and outbreak investigation. An outbreak of pneumonia was associated with one pneumococcal strain among military recruits, previously healthy young men living in a crowded setting. The pneumococcal carriage rate after the outbreak was found to be exceptionally high. PI-1 genes were detected at a rather low prevalence among pneumococcal isolates from children with AOM. However, the study demonstrated that PI-1 has existed among pneumococcal isolates prior to pneumococcal conjugate vaccine and the increased antimicrobial resistance era. Moreover, PI-1 was found to associate with the serotype rather than the genotype. This study adds to our understanding of the molecular epidemiology of MRSA strains in Finland and the importance of an appropriate genotyping method to be able to perform high-level laboratory-based surveillance of MRSA. Epidemiological and molecular analyses of S. pneumoniae add to our knowledge of the characteristics of pneumococcal strains in Finland.

Structure of an amidohydrolase, SACOL0085, from methicillin-resistant Staphylococcus aureus COL

Staphylococcus aureus is an opportunistic pathogen that rapidly acquires resistance to frontline antibiotics. The characterization of novel protein targets from this bacterium is thus an important step towards future therapeutic strategies. Here, the crystal structure of an amidohydrolase, SACOL0085, from S. aureus COL is described. SACOL0085 is a member of the M20D family of peptidases. Unlike other M20D peptidases, which are either monomers or dimers, SACOL0085 adopts a butterfly-shaped homotetrameric arrangement with extensive intersubunit interactions. Each subunit of SACOL0085 contains two Mn2+ ions at the active site. A conserved cysteine residue at the active site distinguishes M20D peptidases from other M20 family members. This cysteine, Cys103, serves as bidentate ligand coordinating both Mn2+ ions in SACOL0085.

Environmental monitoring of bacterial contamination and antibiotic resistance patterns of the fecal coliforms isolated from Cauvery River, a major drinking water source in Karnataka, India

The present study focuses prudent elucidation of microbial pollution and antibiotic sensitivity profiling of the fecal coliforms isolated from River Cauvery, a major drinking water source in Karnataka, India. Water samples were collected from ten hotspots during the year 2011-2012. The physiochemical characteristics and microbial count of water samples collected from most of the hotspots exhibited greater biological oxygen demand and bacterial count especially coliforms in comparison with control samples (p <= 0.01). The antibiotic sensitivity testing was performed using 48 antibiotics against the bacterial isolates by disk-diffusion assay. The current study showed that out of 848 bacterial isolates, 93.51 % (n=793) of the isolates were found to be multidrug-resistant to most of the current generation antibiotics. Among the major isolates, 96.46 % (n=273) of the isolates were found to be multidrug-resistant to 30 antibiotics and they were identified to be Escherichia coli by 16S rDNA gene sequencing. Similarly, 93.85 % (n=107), 94.49 % (n=103), and 90.22 % (n=157) of the isolates exhibited multiple drug resistance to 32, 40, and 37 antibiotics, and they were identified to be Enterobacter cloacae, Pseudomonas trivialis, and Shigella sonnei, respectively. The molecular studies suggested the prevalence of blaTEM genes in all the four isolates and dhfr gene in Escherichia coli and Sh. sonnei. Analogously, most of the other Gram-negative bacteria were found to be multidrug-resistant and the Gram-positive bacteria, Staphylococcus spp. isolated from the water samples were found to be methicillin and vancomycin-resistant Staphylococcus aureus. This is probably the first study elucidating the bacterial pollution and antibiotic sensitivity profiling of fecal coliforms isolated from River Cauvery, Karnataka, India.

Structure of an amidohydrolase, SACOL0085, from methicillin-resistant Staphylococcus aureus COL

Staphylococcus aureus is an opportunistic pathogen that rapidly acquires resistance to frontline antibiotics. The characterization of novel protein targets from this bacterium is thus an important step towards future therapeutic strategies. Here, the crystal structure of an amidohydrolase, SACOL0085, from S. aureus COL is described. SACOL0085 is a member of the M20D family of peptidases. Unlike other M20D peptidases, which are either monomers or dimers, SACOL0085 adopts a butterfly-shaped homotetrameric arrangement with extensive intersubunit interactions. Each subunit of SACOL0085 contains two Mn2+ ions at the active site. A conserved cysteine residue at the active site distinguishes M20D peptidases from other M20 family members. This cysteine, Cys103, serves as bidentate ligand coordinating both Mn2+ ions in SACOL0085.

Prevalence of MRSA and Antimicrobial Resistance of Staphylococcus aureus in Maryland Ground Meat Products

Gemstone Team Antibiotic Resistance

Tackling antibiotic resistance: a dose of common antisense?

Resistance to antimicrobial agents undermines our ability to treat bacterial infections. It attracts intense media and political interest and impacts on personal health and costs to health infrastructures. Bacteria have developed resistance to all licensed antibacterial agents, and their ability to become resistant to unlicensed agents is often demonstrated during the development process. Conventional approaches to antimicrobial development, involving modification of existing agents or production of synthetic derivatives, are unlikely to deliver the range or type of drugs that will be needed to meet all future requirements. Although many companies are seeking novel targets, further radical approaches to both antimicrobial design and the reversal of resistance are now urgently required. In this article, we discuss ‘antisense’ (or ‘antigene’) strategies to inhibit resistance mechanisms at the genetic level. These offer an innovative approach to a global problem and could be used to restore the efficacy of clinically proven agents. Moreover, this strategy has the potential to overcome critical resistances, not only in the so-called ‘superbugs’ (methicillin-resistant Staphylococcus aureus, glycopeptide-resistant enterococci and multidrug-resistant strains of Acinetobacter baumannii, and Pseudomonas aeruginosa), but in resistant strains of any bacterial species.

ß-Lactams: chemical structure, mode of action and mechanisms of resistance

This synopsis summarizes the key chemical and bacteriological characteristics of β-lactams, penicillins, cephalosporins, carbanpenems, monobactams and others. Particular notice is given to first-generation to fifth-generation cephalosporins. This review also summarizes the main resistance mechanism to antibiotics, focusing particular attention to those conferring resistance to broad-spectrum cephalosporins by means of production of emerging cephalosporinases (extended-spectrum β-lactamases and AmpC β-lactamases), target alteration (penicillin-binding proteins from methicillin-resistant Staphylococcus aureus) and membrane transporters that pump β-lactams out of the bacterial cell.

β-Lactams: chemical structure, mode of action and mechanisms of resistance

This synopsis summarizes the key chemical and bacteriological characteristics of β-lactams, penicillins, cephalosporins, carbanpenems, monobactams and others. Particular notice is given to first-generation to fifth-generation cephalosporins. This reviewalso summarizes the main resistancemechanism to antibiotics, focusing particular attention to those conferring resistance to broad-spectrum cephalosporins by means of production of emerging cephalosporinases (extended-spectrum β-lactamases and AmpC β-lactamases), target alteration (penicillin-binding proteins from methicillin-resistant Staphylococcus aureus) and membrane transporters that pump β-lactams out of the bacterial cell.

Antibiotic resistance of Aeromonas hydrophila isolated from marketed fish and prawn of South India

A total of 319 strains of Aeromonas hydrophila were isolated from 536 fish and 278 prawns for a 2-year period. All the strains were tested for resistance to 15 antibiotics and 100% of the strains was resistant to methicillin and rifampicin followed by bacitracin and novobiocin (99%). Only 3% of the strains exhibited resistance against chloramphenicol. The multiple antibiotic resistance (MAR) indexing of A. hydrophila strains showed that all of them originated from high-risk sources

Vergleichende Untersuchungen Methicillin-resistenter Staphylococcus aureus des Klinikums Kassel der Jahre 1999 bis 2004

Die vorliegende Arbeit liefert erstmals einen umfassenden Überblick über die molekulare Epidemiologie von Methicillin resistenten Staphylococcus aureus (MRSA) eines nordhessischen Krankenhauses inklusive seines Umfeldes und deren Entwicklung in einem Zeitraum von fünf Jahren. Von besonderer Bedeutung ist, dass die MRSA-Stämme hierfür nicht nur anhand ihrer SCCmec-Region (staphylococcal cassette chromosome) typisiert wurden, sondern eine weitergehende Charakterisierung auf Grund der Bestimmung des Vorkommens von Antibiotikaresistenz- und Toxingenen, sowie Plasmiden erfolgte. Dabei wurde ein neuer SCCmec-Typ entdeckt und charakterisiert und weitere noch unbekannte SCCmec-Elemente beschrieben. Bei der Charakterisierung der MRSA-Kollektive konnten bzgl. aller untersuchten Eigenschaften im Laufe der Zeit signifikante Veränderungen beobachtet werden. Am deutlichsten waren diese Unterschiede zwischen dem ältesten Kollektiv aus 1999 und allen nachfolgenden Kollektiven. Die Kollektive aus 2001, 2002, 2003 und 2004 zeigten untereinander größere Ähnlichkeiten, aber dennoch gleichzeitig eine tendenziell divergente Entwicklung einzelner Eigenschaften. Besonders auffallend war das dominante Auftreten von SCCmecIV mit 63-87% der Isolate eines Kollektivs ab 2001, gegenüber 16% in 1999. Weiterhin erfolgte eine markante Veränderung im Vorkommen einzelner Antibiotikaresistenzgene von 1999 bis 2004. So waren aacA-aphD und ermA bei MRSA aus 1999 mit 84% bzw. 90% deutlich häufiger als in allen Kollektiven der folgenden Jahre (aacA-aphD: max. 32%, ermA: max. 40%). Wohingegen ermC ein stets zunehmendes Vorkommen von 3% auf 67% über den Untersuchungszeitraum zeigte. Unkontinuierliches aber statistisch relevant vermehrtes Auftreten von tetM konnte bei Isolaten aus 1999 (40%) und 2004 (74%) nachgewiesen werden. Auch bei Toxingenen zeigten sich deutliche Unterschiede in der zeitlichen Verteilung. Ab 2001 zeigten alle Isolate wesentlich höhere Anteile an sec, seg und sei verglichen mit den MRSA aus 1999. So konnte sec im Kollektiv aus 1999 gar nicht nachgewiesen werden, in denen der Folgejahre mit 54-77%. Die Werte für seg und sei stiegen von 48% bzw. 41% in 1999 kontinuierlich auf über 90% in 2004. Die Häufigkeit von MRSA sowohl mit mehreren Resistenzgenen als auch die mit mehreren Toxingenen nahm im Laufe der Zeit zu und korrelierte mit dem Vorkommen von Plasmiden. Bezüglich seiner Korrelation mit den vorkommenden Plasmiden zeigte SCCmecIV im Erhebungszeitraum besonders deutlich eine Veränderung. So nahm über den Zeitraum der Beobachtung die Anzahl der Stämme die zusätzlich zu einem großen Plasmid ein weiteres kleines Plasmid besaßen signifikant zu. Auch beim Vergleich der SCCmec-Typen der MRSA-Isolate konnten Unterschiede bzgl. aller weiteren untersuchten Eigenschaften dargestellt werden. So zeigten z.B. alle SCCmecIIIA das sea-Gen, während dies bei allen anderen in der vorliegenden Arbeit untersuchten SCCmec-Typen nur vereinzelt vorkam. SCCmecII-Stämme wiesen sowohl die meisten Antibiotikaresistenz- als auch Toxingene auf. Es wurde ferner gezeigt, dass Stämme mit vielen Resistenzgenen auch eine hohe Anzahl Toxingene besaßen und dies im Zusammenhang mit einem erhöhten Plasmidgehalt stehen könnte. Aus den MRSA-Kollektiven isolierte Plasmide konnten aufgrund von Restriktionsanalysen als verwandt zu β-Laktamase-Plasmiden des Grundtyps pI524 und pI258 beschrieben werden. Der in vorliegender Arbeit gezeigte Zusammenhang zwischen der Anzahl von direct repeat units (dru) in der Hypervariablen Region (HVR) und dem SCCmec-Typ half den Unterschied zwischen SCCmecIV und SCCmecIVA, sowie die Sonderstellung des in vorliegender Arbeit erstmalig beschriebenen SCCmecIA/II darzustellen. Nicht alle Isolate konnten einem bekannten SCCmec-Typ zugeordnet werden, es handelt sich bei diesen Ausnahmen um weitere noch unbekannte und hier erstmalig beschriebene SCCmec-Typen. Aufgrund der vorliegenden Arbeit konnte ein neuer SCCmec-Typ definiert werden, namentlich der Typ SCCmecIA/II, der seit 1999 in der Region gehäuft vorkommt Die vorliegenden Untersuchungen zeigten somit, dass die Epidemiologie von MRSA der Region Nordhessen trotz bestehender Gemeinsamkeiten zur MRSA-Situation in ganz Deutschland auch Besonderheiten aufweist. Diese nun zu kennen kann einen Beitrag zur gezielten Verbesserung bisheriger Maßnahmen zur Ausbreitungskontrolle von MRSA in der nordhessischen Region leisten.

Characterization of resistance in vitro to different antimicrobial in strains of Staphylococcus spp. in a hospital of the city of Valledupar between January and July 2009

The Staphylococcus spp. they can cause a wide range of infections systemic and located in community and hospital patients. Its high pathogenicity and growing resistance to multiple antimicrobials including methicillin, causes high morbiditymortality rates, causing a high epidemiological impact. Objective: to determine the phenotypic profile of resistance to different antimicrobials in strains of the genus Staphylococcus spp. Materials and methods: collected 75 strains and determined them susceptibility to different antibiotics by the Kirby-Bauer method. The production of betalactamasecheck using the nitrocefin test. (Resistance to Methicillin in S. aureus was conductedusing Mueller Hinton with 4% NaCl and oxacillin 6 μg/mL). Inducible clindamycin resistance tamizo by D-Test test. Results: they were isolated by 38% of staphylococcus coagulase negative (SNA) and 62% of S. aureus. 53% were penicillin resistant staphylococci: S. aureus with 58% and 42% SNA. 47% of the strains showed resistance to methicillin: S. aureus with 61% and SNA with 39%. A strain of S. aureus showed inducible resistance to clindamycin (1.33%). Coagulase negative staphylococci were isolated mostly from blood samples (31%), blood (29%), tip of catheter (5%) and came mostly from neonatal ICU (25%), medical (21%) and surgery (16%).Conclusions: S. aureus and SNA were isolated with greater frequency in blood and wounds from surgery and neonatal ICU. The predominant resistance phenotypes were penicillin and oxacillin.

Antibacterials and modulators of bacterial resistance from the immature cones of Chamaecyparis lawsoniana

As part of an on-going project to characterize compounds from immature conifer cones with antibacterial or modulatory activity against multidrug-resistant (MDR) strains of Staphylococcus aureus, eight compounds were isolated from the cones of Chatnaecyparis lawsoniana. The active compounds were mainly diterpenes, with minimum inhibitory concentrations ranging from 4 to 128 mu g/ml against MDR effluxing S. aureus strains and two epidemic methicillin-resistant (EMRSA) clinical isolates. The compounds extracted were the diterpenes ferruginol, pisiferol and its epimer 5-epipisiferol, formosanoxide, trans-communic acid and torulosal, the sesquiterpene oplopanonyl acetate and the germacrane 4 beta-hydroxygermacra-1(10)-5-diene. Some of these compounds also exhibited modulatory activity in potentiating antibiotic activity against effluxing strains and ferruginol, used at a sub-inhibitory concentration, resulted in an 80-fold potentiation of oxacillin activity against strain EMRSA-15. An efflux inhibition assay using an S. aureus strain possessing the MDR NorA efflux pump resulted in 40% inhibition of ethidium bromide efflux at 10 mu M ferruginol (2.86 mu g/ml). We report the H-1 and C-13 NMR data for the cis A/B ring junction epimer of pisiferol which we have named 5-epipisiferol. We also unambiguously assign all H-1 and C-13 NMR resonances for trans-communic acid. (c) 2006 Elsevier Ltd. All rights reserved.

Prediction of Staphylococcus aureus antimicrobial resistance by whole-genome sequencing

Whole-genome sequencing (WGS) could potentially provide a single platform for extracting all the information required to predict an organism’s phenotype. However, its ability to provide accurate predictions has not yet been demonstrated in large independent studies of specific organisms. In this study, we aimed to develop a genotypic prediction method for antimicrobial susceptibilities. The whole genomes of 501 unrelated Staphylococcus aureus isolates were sequenced, and the assembled genomes were interrogated using BLASTn for a panel of known resistance determinants (chromosomal mutations and genes carried on plasmids). Results were compared with phenotypic susceptibility testing for 12 commonly used antimicrobial agents (penicillin, methicillin, erythromycin, clindamycin, tetracycline, ciprofloxacin, vancomycin, trimethoprim, gentamicin, fusidic acid, rifampin, and mupirocin) performed by the routine clinical laboratory. We investigated discrepancies by repeat susceptibility testing and manual inspection of the sequences and used this information to optimize the resistance determinant panel and BLASTn algorithm. We then tested performance of the optimized tool in an independent validation set of 491 unrelated isolates, with phenotypic results obtained in duplicate by automated broth dilution (BD Phoenix) and disc diffusion. In the validation set, the overall sensitivity and specificity of the genomic prediction method were 0.97 (95% confidence interval [95% CI], 0.95 to 0.98) and 0.99 (95% CI, 0.99 to 1), respectively, compared to standard susceptibility testing methods. The very major error rate was 0.5%, and the major error rate was 0.7%. WGS was as sensitive and specific as routine antimicrobial susceptibility testing methods. WGS is a promising alternative to culture methods for resistance prediction in S. aureus and ultimately other major bacterial pathogens.

The Challenges of Antimicrobial Resistance in Brazil

Brazil is a country with continental proportions with high geographic and economic diversity. Despite its medical centers of excellence, antimicrobial resistance poses a major therapeutic challenge. Rates of methicillin-resistant Staphylococcus aureus are up to 60% and are related to an endemic Brazilian clone. Local resistance to vancomycin in Enterococci was first related to Enterococcus faecalis, which differs from European and American epidemiology. Also, local Klebsiella pneumoniae and Escherichia coli isolates producing extended-spectrum beta-lactamases have a much higher prevalence (40%-50% and 10%-18%, respectively). Carbapenem resistance among the enterobacteriaceae group is becoming a major problem, and K. pneumoniae carbapenemase isolates have been reported in different states. Among nonfermenters, carbapenem resistance is strongly related to SPM-1 (Pseudomonasaeruginosa) and OXA-23 (Acinetobacter baumannii complex) enzymes, and a colistin-only susceptible phenotype has also emerged in these isolates, which is worrisome. Local actions without loosing the global resistance perspective will demand multidisciplinary actions, new policies, and political engagement.