scholarly journals Mupirocin and Chlorhexidine Resistance in Staphylococcus aureus in Patients with Community-Onset Skin and Soft Tissue Infections

2012 ◽  
Vol 57 (1) ◽  
pp. 559-568 ◽  
Author(s):  
Stephanie A. Fritz ◽  
Patrick G. Hogan ◽  
Bernard C. Camins ◽  
Ali J. Ainsworth ◽  
Carol Patrick ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Soft Tissue ◽  
Routine Care ◽  
Soft Tissue Infections ◽  
Content Type ◽  
Before And After ◽  
Intranasal Mupirocin ◽  
Mupirocin Resistance ◽  
High Level ◽  
Community Onset

ABSTRACTDecolonization measures, including mupirocin and chlorhexidine, are often prescribed to preventStaphylococcus aureusskin and soft tissue infections (SSTI). The objective of this study was to determine the prevalence of high-level mupirocin and chlorhexidine resistance inS. aureusstrains recovered from patients with SSTI before and after mupirocin and chlorhexidine administration and to determine whether carriage of a mupirocin- or chlorhexidine-resistant strain at baseline precludedS. aureuseradication. We recruited 1,089 patients with community-onset SSTI with or withoutS. aureuscolonization. In addition to routine care, 483 patients were enrolled in a decolonization trial: 408 received intranasal mupirocin (with or without antimicrobial baths), and 258 performed chlorhexidine body washes. Patients were followed for up to 12 months with repeat colonization cultures. AllS. aureusisolates were tested for high-level mupirocin and chlorhexidine resistance. At baseline, 23/1,089 (2.1%) patients carried a mupirocin-resistantS. aureusstrain and 10/1,089 (0.9%) patients carried chlorhexidine-resistantS. aureus. Of 4 patients prescribed mupirocin, who carried a mupirocin-resistantS. aureusstrain at baseline, 100% remained colonized at 1 month compared to 44% of the 324 patients without mupirocin resistance at baseline (P= 0.041). Of 2 patients prescribed chlorhexidine, who carried a chlorhexidine-resistantS. aureusstrain at baseline, 50% remained colonized at 1 month compared to 48% of the 209 patients without chlorhexidine resistance at baseline (P= 1.0). The overall prevalence of mupirocin and chlorhexidine resistance is low inS. aureusisolates recovered from outpatients, but eradication efforts were less successful in patients carrying a mupirocin-resistantS. aureusstrain at baseline.

scholarly journals Mupirocin Resistance in Staphylococcus aureus Causing Recurrent Skin and Soft Tissue Infections in Children

2011 ◽  
Vol 55 (5) ◽  
pp. 2431-2433 ◽  
Author(s):  
J. Chase McNeil ◽  
Kristina G. Hulten ◽  
Sheldon L. Kaplan ◽  
Edward O. Mason
Keyword(s):  
Staphylococcus Aureus ◽  
Soft Tissue ◽  
Trna Synthetase ◽  
Soft Tissue Infections ◽  
Methicillin Resistant ◽  
Content Type ◽  
Plasmid Gene ◽  
Children's Hospital ◽  
Children’S Hospital ◽  
Mupirocin Resistance

ABSTRACTStaphylococcus aureusresistance to mupirocin is often caused by acquisition of a novel isoleucyl-tRNA synthetase encoded on the plasmid genemupA. We testedS. aureusisolates from children at Texas Children's Hospital with recurrent skin and soft tissue infections for mupirocin resistance andmupA. Of 136 isolates, 20 were resistant to mupirocin (14.7%). Fifteen isolates (11%) carriedmupA, and the gene was more common in methicillin-susceptibleS. aureus(21.4%) than methicillin-resistantS. aureus(8.3%;P= 0.03). Seven of 20 mupirocin-resistant isolates displayed clindamycin resistance.

scholarly journals Role of Antibodies in Protection Elicited by Active Vaccination with Genetically Inactivated Alpha Hemolysin in a Mouse Model of Staphylococcus aureus Skin and Soft Tissue Infections

2014 ◽  
Vol 21 (5) ◽  
pp. 622-627 ◽  
Author(s):  
Christopher P. Mocca ◽  
Rebecca A. Brady ◽  
Drusilla L. Burns
Keyword(s):  
Staphylococcus Aureus ◽  
Soft Tissue ◽  
Murine Model ◽  
Bacterial Colonization ◽  
Passive Immunization ◽  
The United States ◽  
Soft Tissue Infections ◽  
Content Type ◽  
Alpha Hemolysin ◽  
Active Vaccination

ABSTRACTDue to the emergence of highly virulent community-associated methicillin-resistantStaphylococcus aureus(CA-MRSA) infections,S. aureushas become a major threat to public health. A majority of CA-MRSA skin and soft tissue infections in the United States are caused byS. aureusUSA300 strains that are known to produce high levels of alpha hemolysin (Hla). Therefore, vaccines that contain inactivated forms of this toxin are currently being developed. In this study, we sought to determine the immune mechanisms of protection for this antigen using a vaccine composed of a genetically inactivated form of Hla (HlaH35L). Using a murine model of skin and soft tissue infections (SSTI), we found that BALB/c mice were protected by vaccination with HlaH35L; however, Jh mice, which are deficient in mature B lymphocytes and lack IgM and IgG in their serum, were not protected. Passive immunization with anti-HlaH35L antibodies conferred protection against bacterial colonization. Moreover, we found a positive correlation between the total antibody concentration induced by active vaccination and reduced bacterial levels. Animals that developed detectable neutralizing antibody titers after active vaccination were significantly protected from infection. These data demonstrate that antibodies to Hla represent the major mechanism of protection afforded by active vaccination with inactivated Hla in this murine model of SSTI, and in this disease model, antibody levels correlate with protection. These results provide important information for the future development and evaluation ofS. aureusvaccines.

scholarly journals Prevalence of Chlorhexidine-Resistant Methicillin-Resistant Staphylococcus aureus following Prolonged Exposure

2014 ◽  
Vol 58 (8) ◽  
pp. 4404-4410 ◽  
Author(s):  
Carey D. Schlett ◽  
Eugene V. Millar ◽  
Katrina B. Crawford ◽  
Tianyuan Cui ◽  
Jeffrey B. Lanier ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Molecular Analysis ◽  
Prolonged Exposure ◽  
Controlled Trial ◽  
Epidemiological Data ◽  
Methicillin Resistant ◽  
Content Type ◽  
Mupirocin Resistance ◽  
High Level ◽  
Study Participants

ABSTRACTChlorhexidine has been increasingly utilized in outpatient settings to control methicillin-resistantStaphylococcus aureus(MRSA) outbreaks and as a component of programs for MRSA decolonization and prevention of skin and soft-tissue infections (SSTIs). The objective of this study was to determine the prevalence of chlorhexidine resistance in clinical and colonizing MRSA isolates obtained in the context of a community-based cluster-randomized controlled trial for SSTI prevention, during which 10,030 soldiers were issued chlorhexidine for body washing. We obtained epidemiological data on study participants and performed molecular analysis of MRSA isolates, including PCR assays for determinants of chlorhexidine resistance and high-level mupirocin resistance and pulsed-field gel electrophoresis (PFGE). During the study period, May 2010 to January 2012, we identified 720 MRSA isolates, of which 615 (85.4%) were available for molecular analysis, i.e., 341 clinical and 274 colonizing isolates. Overall, only 10 (1.6%) of 615 isolates were chlorhexidine resistant, including three from the chlorhexidine group and seven from nonchlorhexidine groups (P> 0.99). Five (1.5%) of the 341 clinical isolates and five (1.8%) of the 274 colonizing isolates harbored chlorhexidine resistance genes, and four (40%) of the 10 possessed genetic determinants for mupirocin resistance. All chlorhexidine-resistant isolates were USA300. The overall prevalence of chlorhexidine resistance in MRSA isolates obtained from our study participants was low. We found no association between extended chlorhexidine use and the prevalence of chlorhexidine-resistant MRSA isolates; however, continued surveillance is warranted, as this agent continues to be utilized for infection control and prevention efforts.

Management of Skin and Soft-Tissue Infections Before and After Clinical Pathway Implementation

2017 ◽  
Vol 57 (6) ◽  
pp. 660-666 ◽  
Author(s):  
Courtney E. Nelson ◽  
Aaron Chen ◽  
Lisa McAndrew ◽  
Khoon-Yen Tay ◽  
Fran Balamuth
Keyword(s):  
Emergency Department ◽  
Staphylococcus Aureus ◽  
Soft Tissue ◽  
Length Of Stay ◽  
Clinical Pathway ◽  
Methicillin Resistant Staphylococcus Aureus ◽  
Antibiotic Use ◽  
Soft Tissue Infections ◽  
Before And After ◽  
Systemic Antibiotics

We evaluated if the introduction of a clinical pathway for skin and soft-tissue infections (SSTIs) would reduce methicillin-resistant Staphylococcus aureus (MRSA)-directed therapy for simple cellulitis and antibiotic use for simple abscess after drainage. We compared the treatment of SSTI during a 3-month prepathway and 11-month postpathway period. We included patients 57 days to 18 years old discharged from the emergency department (ED) with a diagnosis of cellulitis or abscess. Balancing measures included 72-hour revisit rate and ED length of stay (LOS). A total of 291 patients prepathway and 781 patients postpathway were included. The proportion of patients with simple cellulitis prescribed MRSA-directed therapy decreased from 81% to 54% postpathway. The proportion of patients with a drained abscess prescribed systemic antibiotics decreased from 88% to 75%. There was no increase in 72-hour revisit rates (3.8% vs 3.2%, P = .64) or ED LOS (2.8 vs 2.7 hours, P = .05).

scholarly journals Chlorhexidine and Mupirocin Susceptibility of Methicillin-Resistant Staphylococcus aureus Isolates in the REDUCE-MRSA Trial

2016 ◽  
Vol 54 (11) ◽  
pp. 2735-2742 ◽  
Author(s):  
Mary K. Hayden ◽  
Karen Lolans ◽  
Katherine Haffenreffer ◽  
Taliser R. Avery ◽  
Ken Kleinman ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Methicillin Resistant Staphylococcus Aureus ◽  
Cluster Randomized Trial ◽  
Confidence Limits ◽  
Methicillin Resistant ◽  
Content Type ◽  
Mrsa Infection ◽  
Mupirocin Resistance ◽  
Cluster Randomized ◽  
High Level

Whether targeted or universal decolonization strategies for the control of methicillin-resistant Staphylococcus aureus (MRSA) select for resistance to decolonizing agents is unresolved. The REDUCE-MRSA trial (ClinicalTrials registration no. NCT00980980) provided an opportunity to investigate this question. REDUCE-MRSA was a 3-arm, cluster-randomized trial of either screening and isolation without decolonization, targeted decolonization with chlorhexidine and mupirocin, or universal decolonization without screening to prevent MRSA infection in intensive-care unit (ICU) patients. Isolates from the baseline and intervention periods were collected and tested for susceptibility to chlorhexidine gluconate (CHG) by microtiter dilution; mupirocin susceptibility was tested by Etest. The presence of the qacA or qacB gene was determined by PCR and DNA sequence analysis. A total of 3,173 isolates were analyzed; 2 were nonsusceptible to CHG (MICs, 8 μg/ml), and 5/814 (0.6%) carried qacA or qacB . At baseline, 7.1% of MRSA isolates expressed low-level mupirocin resistance, and 7.5% expressed high-level mupirocin resistance. In a mixed-effects generalized logistic regression model, the odds of mupirocin resistance among clinical MRSA isolates or MRSA isolates acquired in an ICU in intervention versus baseline periods did not differ across arms, although estimates were imprecise due to small numbers. Reduced susceptibility to chlorhexidine and carriage of qacA or qacB were rare among MRSA isolates in the REDUCE-MRSA trial. The odds of mupirocin resistance were no different in the intervention versus baseline periods across arms, but the confidence limits were broad, and the results should be interpreted with caution.

scholarly journals High Staphylococcus aureus Colonization Prevalence among Patients with Skin and Soft Tissue Infections and Controls in an Urban Emergency Department

2014 ◽  
Vol 53 (3) ◽  
pp. 810-815 ◽  
Author(s):  
Neha Kumar ◽  
Michael Z. David ◽  
Susan Boyle-Vavra ◽  
Julia Sieth ◽  
Robert S. Daum
Keyword(s):  
Staphylococcus Aureus ◽  
Soft Tissue ◽  
The United States ◽  
Antimicrobial Treatment ◽  
Soft Tissue Infections ◽  
Content Type ◽  
Treatment Regimens ◽  
Commensal Species ◽  
High Prevalence

Staphylococcus aureusis a commensal species that can also be a formidable pathogen. In the United States, an epidemic of community-acquired methicillin-resistantStaphylococcus aureus(MRSA) infections has been occurring for the last 15 years. In the context of a study in which we identified patients with skin and soft tissue infections (SSTIs) and randomized them to receive one of two antimicrobial treatment regimens, we assessedS. aureuscolonization in the nares, throat, and perianal skin on the day of enrollment and 40 days after therapy. We compared the prevalence of colonization between the SSTI patients and an uninfected control population. A total of 144 subjects and 130 controls, predominantly African American, participated in this study, and 116 returned for a 40-day follow-up visit. Of the SSTI patients, 76% were colonized withS. aureusat enrollment, as were 65% of the controls. Patients were more likely than the controls to be colonized with USA300 MRSA (62/144 [43.1%] versus 11/130 [8.5%], respectively;P< 0.001). The nares were not the most common site of colonization. The colonization prevalence diminished somewhat after antibiotic treatment but remained high. The isolates that colonized the controls were more likely than those in the patients to be methicillin-susceptibleS. aureus(MSSA) (74/84 [88.1%] versus 56/106 [52.8%], respectively;P< 0.001). In conclusion, the prevalence ofS. aureuscolonization among SSTI patients was high and often involved USA300 MRSA. The prevalence diminished somewhat with antimicrobial therapy but remained high at the 40-day follow-up visit. Control subjects were also colonized at a high prevalence but most often with a genetic background not associated with a clinical infection in this study.S. aureusis a commensal species and a pathogen. Plans for decolonization or eradication should take this distinction into account.

scholarly journals Whole-Genome Sequences of Staphylococcus aureus Isolates from Positive Blood Cultures

2021 ◽  
Vol 10 (43) ◽  
Author(s):  
Itidal Reslane ◽  
Margaret Sladek ◽  
Paul D. Fey ◽  
Baha Abdalhamid
Keyword(s):  
Staphylococcus Aureus ◽  
Soft Tissue ◽  
Draft Genome ◽  
Bloodstream Infections ◽  
Blood Cultures ◽  
Whole Genome ◽  
Soft Tissue Infections ◽  
Genome Sequences ◽  
Content Type ◽  
Clinical Strains

Staphylococcus aureus is a major cause of skin and soft tissue infections as well as bloodstream infections worldwide. Here, we report the draft genome sequences of 18 deidentified S. aureus clinical strains collected from positive blood cultures.

scholarly journals Molecular Types of Methicillin-Resistant Staphylococcus aureus and Methicillin-Sensitive S. aureus Strains Causing Skin and Soft Tissue Infections and Nasal Colonization, Identified in Community Health Centers in New York City

2015 ◽  
Vol 53 (8) ◽  
pp. 2648-2658 ◽  
Author(s):  
Maria Pardos de la Gandara ◽  
Juan Antonio Raygoza Garay ◽  
Michael Mwangi ◽  
Jonathan N. Tobin ◽  
Amanda Tsang ◽  
...  
Keyword(s):  
New York ◽  
Staphylococcus Aureus ◽  
New York City ◽  
Soft Tissue ◽  
York City ◽  
Community Health Centers ◽  
Health Centers ◽  
Soft Tissue Infections ◽  
Content Type ◽  
Clonal Type

In November 2011, The Rockefeller University Center for Clinical and Translational Science (CCTS), the Laboratory of Microbiology and Infectious Diseases, and Clinical Directors Network (CDN) launched a research and learning collaborative project with six community health centers in the New York City metropolitan area to determine the nature (clonal type) of community-acquiredStaphylococcus aureusstrains causing skin and soft tissue infections (SSTIs). Between November 2011 and March 2013, wound and nasal samples from 129 patients with active SSTIs suspicious forS. aureuswere collected and characterized by molecular typing techniques. In 63 of 129 patients, the skin wounds were infected byS. aureus: methicillin-resistantS. aureus(MRSA) was recovered from 39 wounds and methicillin-sensitiveS. aureus(MSSA) was recovered from 24. Most—46 of the 63–wound isolates belonged to the CC8/Panton-Valentine leukocidin-positive (PVL+) group ofS. aureusclone USA300: 34 of these strains were MRSA and 12 were MSSA. Of the 63 patients withS. aureusinfections, 30 were also colonized byS. aureusin the nares: 16 of the colonizing isolates were MRSA, and 14 were MSSA, and the majority of the colonizing isolates belonged to the USA300 clonal group. In most cases (70%), the colonizing isolate belonged to the same clonal type as the strain involved with the infection. In three of the patients, the identity of invasive and colonizing MRSA isolates was further documented by whole-genome sequencing.

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