Clinical Features, Outcomes, and Molecular Characteristics of Community- and Health Care-Associated Staphylococcus lugdunensis Infections

Staphylococcus lugdunensisis a major cause of aggressive endocarditis, but it is also responsible for a broad spectrum of infections. The differences in clinical and molecular characteristics between community-associated (CA) and health care-associated (HA)S. lugdunensisinfections have remained unclear. We performed a retrospective study ofS. lugdunensisinfections between 2003 and 2014 to compare the clinical and molecular characteristics of CA and HA isolates. We collected 129S. lugdunensisisolates in total: 81 (62.8%) HA isolates and 48 (37.2%) CA isolates. HA infections were more frequent than CA infections in children (16.0% versus 4.2%, respectively;P= 0.041) and the elderly (38.3% versus 14.6%, respectively;P= 0.004). The CA isolates were more likely to cause skin and soft tissue infections (85.4% versus 19.8%, respectively;P< 0.001). HA isolates were more frequently responsible for bacteremia of unknown origin (34.6% versus 4.2%, respectively;P< 0.001) and for catheter-related bacteremia (12.3% versus 0%, respectively;P= 0.011) than CA isolates. Fourteen-day mortality was higher for HA infections than for CA infections (11.1% versus 0%, respectively). A higher proportion of the HA isolates than of the CA isolates were resistant to penicillin (76.5% versus 52.1%, respectively;P= 0.004) and oxacillin (32.1% versus 2.1%, respectively;P< 0.001). Two major clonal complexes (CC1 and CC3) were identified. Sequence type 41 (ST41) was the most common sequence type identified (29.5%). The proportion of ST38 isolates was higher for HA than for CA infections (33.3% versus 12.5%, respectively;P= 0.009). These isolates were of staphylococcal cassette chromosomemecelement (SCCmec)type IV, V, or Vt. HA and CAS. lugdunensisinfections differ in terms of their clinical features, outcome, antibiotic susceptibilities, and molecular characteristics.

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Does an impaired capacity for self-care impact the prevalence of social and emotional loneliness among elderly people?

Working with Older People ◽

10.1108/wwop-01-2018-0001 ◽

2018 ◽

Vol ahead-of-print (ahead-of-print) ◽

Author(s):

Irena Canjuga ◽

Danica Železnik ◽

Marijana Neuberg ◽

Marija Božicevic ◽

Tina Cikac

Keyword(s):

Health Care ◽

Elderly People ◽

Age Distribution ◽

Self Care ◽

The Elderly ◽

The Self ◽

Content Type ◽

Care Assessment ◽

Significant Difference ◽

The Impact

Purpose The purpose of this paper is to explore the impact of self-care on the prevalence of loneliness among elderly people living in retirement homes and older people living in their homes/communities. Design/methodology/approach The research was conducted through standardized SELSA-L assessment loneliness questionnaires and the Self Care Assessment Worksheet for self-care assessment. The results were processed using the Kruskal–Wallis test. Findings The obtained results have shown that impaired self-care ability affects the prevalence of loneliness among the elderly almost the same in both groups of participants. However, regarding the relationship between the state of health and self-care, only a statistically significant difference in the prevalence of loneliness is found in the case of the participants living in their homes, with the worst health condition affecting the poorer psychological care. Research limitations/implications It is necessary to point out the limitations of the research, primarily sample limitations and the selected design of the study. The sample consisted of two different and relatively small groups of participants which could adversely affect the representativeness of the sample and reduce the possibility of generalising the results. The next limiting factor is the age distribution the authors used in the research, where the age of the participants as a very important variable was collected by age range and not precisely which consequently resulted in inequality in subgroup sizes. Thus, the middle age (75–85) covers up to ten years, which is a huge range at an older age and can mean major differences in functional ability, and can impact the self-care assessment. Practical implications Nurses are indispensable in care for the elderly and they need to promote and encourage self-care of the elderly through health care. Elderly people living in retirement homes should be allowed to participate equally in health care in order to preserve their own autonomy and dignity. However, to benefit those who live in their homes, nurses should be connected to the local community and thus stimulate various forms of preventative (testing blood sugar levels, blood pressure and educating on the importance of preventive examinations) or recreational activities in the environment of elderly people with the goal of preserving their functional abilities. Originality/value The impact of self-care on loneliness was not sufficiently researched, and this paper contributed to understanding the complexity of loneliness phenomena among the elderly with the aim of developing a model of prevention.

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Vaccine Protection against Multidrug-Resistant Klebsiella pneumoniae in a Nonhuman Primate Model of Severe Lower Respiratory Tract Infection

mBio ◽

10.1128/mbio.02994-19 ◽

2019 ◽

Vol 10 (6) ◽

Cited By ~ 3

Author(s):

Natalia Malachowa ◽

Scott D. Kobayashi ◽

Adeline R. Porter ◽

Brett Freedman ◽

Patrick W. Hanley ◽

...

Keyword(s):

United States ◽

Risk Factors ◽

Health Care ◽

Lower Respiratory Tract ◽

The United States ◽

Multidrug Resistant ◽

Sequence Type ◽

Content Type ◽

Carbapenem Resistant ◽

Cynomolgus Macaques

ABSTRACT Klebsiella pneumoniae is a human gut communal organism and notorious opportunistic pathogen. The relative high burden of asymptomatic colonization by K. pneumoniae is often compounded by multidrug resistance—a potential problem for individuals with significant comorbidities or other risk factors for infection. A carbapenem-resistant K. pneumoniae strain classified as multilocus sequence type 258 (ST258) is widespread in the United States and is usually multidrug resistant. Thus, treatment of ST258 infections is often difficult. Inasmuch as new preventive and/or therapeutic measures are needed for treatment of such infections, we developed an ST258 pneumonia model in cynomolgus macaques and tested the ability of an ST258 capsule polysaccharide type 2 (CPS2) vaccine to moderate disease severity. Compared with sham-vaccinated animals, those vaccinated with ST258 CPS2 had significantly less disease as assessed by radiography 24 h after intrabronchial installation of 108 CFU of ST258. All macaques vaccinated with CPS2 ultimately developed ST258-specific antibodies that significantly enhanced serum bactericidal activity and killing of ST258 by macaque neutrophils ex vivo. Consistent with a protective immune response to CPS2, transcripts encoding inflammatory mediators were increased in infected lung tissues obtained from CPS-vaccinated animals compared with control, sham-vaccinated macaques. Taken together, our data provide support for the idea that vaccination with ST258 CPS can be used to prevent or moderate infections caused by ST258. As with studies performed decades earlier, we propose that this prime-boost vaccination approach can be extended to include multiple capsule types. IMPORTANCE Multidrug-resistant bacteria continue to be a major problem worldwide, especially among individuals with significant comorbidities and other risk factors for infection. K. pneumoniae is among the leading causes of health care-associated infections, and the organism is often resistant to multiple classes of antibiotics. A carbapenem-resistant K. pneumoniae strain known as multilocus sequence type 258 (ST258) is the predominant carbapenem-resistant Enterobacteriaceae in the health care setting in the United States. Infections caused by ST258 are often difficult to treat and new prophylactic measures and therapeutic approaches are needed. To that end, we developed a lower respiratory tract infection model in cynomolgus macaques in which to test the ability of ST258 CPS to protect against severe ST258 infection.

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Clinical and Molecular Characterization of Invasive Heteroresistant Vancomycin-Intermediate Staphylococcus aureus Infections in Korean Hospitals

Journal of Clinical Microbiology ◽

10.1128/jcm.02595-15 ◽

2015 ◽

Vol 54 (3) ◽

pp. 760-763 ◽

Cited By ~ 7

Author(s):

Eu Suk Kim ◽

In-Gyu Bae ◽

Jeong Eun Cho ◽

Yun Jung Choi ◽

Il-Hwan Kim ◽

...

Keyword(s):

Health Care ◽

Staphylococcus Aureus ◽

Molecular Characterization ◽

Sequence Type ◽

Content Type ◽

Health Care Associated Infections ◽

Persistent Bacteremia

Invasive heteroresistant vancomycin-intermediateStaphylococcus aureus(h-VISA) isolates were identified and characterized in 10 Korean hospitals from July 2009 to June 2011. The prevalence of h-VISA infections was 3.3% (42/1,289). Most (41/42) were health care-associated infections caused by strains belonging to sequence type 5. Cases of persistent bacteremia were frequent (17/42), and 30-day mortality was high (16/40).

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First Report ofcfr-Carrying Plasmids in the Pandemic Sequence Type 22 Methicillin-Resistant Staphylococcus aureus Staphylococcal Cassette ChromosomemecType IV Clone

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.02949-15 ◽

2016 ◽

Vol 60 (5) ◽

pp. 3007-3015 ◽

Cited By ~ 21

Author(s):

Anna C. Shore ◽

Alexandros Lazaris ◽

Peter M. Kinnevey ◽

Orla M. Brennan ◽

Gráinne I. Brennan ◽

...

Keyword(s):

Staphylococcus Aureus ◽

Ribosomal Proteins ◽

Resistance Mechanisms ◽

Sequence Type ◽

23S Rrna ◽

Methicillin Resistant ◽

Content Type ◽

First Report ◽

Type Iv ◽

Linezolid Resistance

ABSTRACTLinezolid is often the drug of last resort for serious methicillin-resistantStaphylococcus aureus(MRSA) infections. Linezolid resistance is mediated by mutations in 23S rRNA and genes for ribosomal proteins;cfr, encoding phenicol, lincosamide, oxazolidinone, pleuromutilin, and streptogramin A (PhLOPSA) resistance; its homologuecfr(B); oroptrA, conferring oxazolidinone and phenicol resistance. Linezolid resistance is rare inS. aureus, andcfris even rarer. This study investigated the clonality and linezolid resistance mechanisms of two MRSA isolates from patients in separate Irish hospitals. Isolates were subjected tocfrPCR, PhLOPSAsusceptibility testing, 23S rRNA PCR and sequencing, DNA microarray profiling,spatyping, pulsed-field gel electrophoresis (PFGE), plasmid curing, and conjugative transfer. Whole-genome sequencing was used for single-nucleotide variant (SNV) analysis, multilocus sequence typing, L protein mutation identification,cfrplasmid sequence analysis, andoptrAandcfr(B) detection. Isolates M12/0145 and M13/0401 exhibited linezolid MICs of 64 and 16 mg/liter, respectively, and harbored identical 23S rRNA and L22 mutations, but M12/0145 exhibited the mutation in 2/6 23S rRNA alleles, compared to 1/5 in M13/0401. Both isolates were sequence type 22 MRSA staphylococcal cassette chromosomemectype IV (ST22-MRSA-IV)/spatype t032 isolates, harboredcfr, exhibited the PhLOPSAphenotype, and lackedoptrAandcfr(B). They differed by five PFGE bands and 603 SNVs. Isolate M12/0145 harboredcfrandfexAon a 41-kb conjugative pSCFS3-type plasmid, whereas M13/0401 harboredcfrandlsa(B) on a novel 27-kb plasmid. This is the first report ofcfrin the pandemic ST22-MRSA-IV clone. Differentcfrplasmids and mutations associated with linezolid resistance in genotypically distinct ST22-MRSA-IV isolates highlight that prudent management of linezolid use is essential.

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Molecular characteristics and risk factor analysis of Staphylococcus aureus colonization put insight into CC1 colonization in three nursing homes in Shanghai

PLoS ONE ◽

10.1371/journal.pone.0253858 ◽

2021 ◽

Vol 16 (10) ◽

pp. e0253858

Author(s):

Wei-Ping He ◽

Fei-Fei Gu ◽

Ji Zhang ◽

Xin-Xin Li ◽

Shu-Zhen Xiao ◽

...

Keyword(s):

Risk Factors ◽

Staphylococcus Aureus ◽

Nursing Homes ◽

Molecular Epidemiology ◽

Protein A ◽

The Elderly ◽

Sequence Type ◽

Molecular Characteristics ◽

Type I ◽

Potential Risk Factors

Research indicates that Staphylococcus aureus colonization in the elderly with predisposing risks is associated with subsequent infection. However, the molecular epidemiology and risk factors for S. aureus colonization among residents and staff in nursing homes (NHs) in China remain unclear. A multicenter study was conducted in three NHs in Shanghai between September 2019 and October 2019. We explored the prevalence, molecular epidemiology, and risk factors for S. aureus colonization. All S. aureus isolates were characterized based on antimicrobial resistance, virulence genes, multilocus sequence typing (MLST), staphylococcus protein A (spa) typing, and staphylococcal cassette chromosome mec (SCCmec) typing. NH records were examined for potential risk factors for S. aureus colonization. S. aureus and methicillin-resistant S. aureus (MRSA) isolates were detected in 109 (100 residents and 9 staff, 19.8%, 109/551) and 28 (24 residents and 4 staff, 5.1%, 28/551) subjects among 496 residents and 55 staff screened, respectively. Compared to methicillin-susceptible S. aureus isolates, all 30 MRSA isolates had higher resistance rates to most antibiotics except minocycline, rifampicin, linezolid, vancomycin, and teicoplanin. Sequence type (ST) 1 (21.3%) was the most common sequence type, and t127 (20.5%) was the most common spa type among 122 S. aureus isolates. SCCmec type I (70%) was the dominant clone among all MRSA isolates. CC1 (26/122, 21.3%) was the predominant complex clone (CC), followed by CC398 (25/122, 20.5%), CC5 (20/122, 16.4%) and CC188 (18/122, 14.8%). Female sex (OR, 1.70; 95% CI, 1.04–2.79; P = 0.036) and invasive devices (OR, 2.19; 95% CI, 1.26–3.81; P = 0.006) were independently associated with S. aureus colonization.

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Consumption patterns and demand in households headed by the elderly: evidence from Brazil

International Journal of Social Economics ◽

10.1108/ijse-06-2020-0356 ◽

2021 ◽

Vol ahead-of-print (ahead-of-print) ◽

Author(s):

Guilherme Fonseca Travassos ◽

Alexandre Bragança Coelho ◽

Mary Paula Arends-Kuenning

Keyword(s):

Health Care ◽

Young Adult ◽

The Elderly ◽

Household Consumption ◽

Consumption Patterns ◽

Demand System ◽

Sample Design ◽

Content Type ◽

Demand Models ◽

Socioeconomic And Demographic Factors

Purpose The main objective of this paper is to analyze patterns of consumption expenditure and the effects of income, prices and socioeconomic and demographic factors on demand among elderly- and young-adult-headed households in Brazil. Design/methodology/approach The authors estimated a Quadratic Almost Ideal Demand System demand system using the main household consumption good groups – food, housing, clothing, transportation, health care and other expenses – with data from three Brazilian Household Budget surveys. Findings The study results showed that elderly- and young-adult-headed households have different consumption patterns. The consumption of food, transportation and health care was more price-sensitive for households headed by the elderly, while higher income increases health care expenses in elderly-headed households to a greater extent than it does in younger-headed households. Research limitations/implications The limitations are due to the structure of the data used, such as the effects of seasonality and individualized demand analyses, and sample design in the estimates. However, due to the structure of the demand models, which when estimating by seemingly unrelated regressions do not allow to take into account the sample design. Practical implications As a consequence of population aging, the Brazilian economy will experience changes in the composition of household consumption, mainly for food, housing, transportation and health-care-related products. Originality/value This paper fulfills the lack of studies that analyze the consumption patterns and how demand varies across different types of elderly-headed households in a developing country, such as Brazil.

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Assessing unmet health-care needs of the elderly in west of Iran: A case study

International Journal of Human Rights in Healthcare ◽

10.1108/ijhrh-09-2020-0083 ◽

2021 ◽

Vol ahead-of-print (ahead-of-print) ◽

Author(s):

Bakhtiar Piroozi ◽

Farman Zahir Abdullah ◽

Amjad Mohamadi-Bolbanabad ◽

Hossein Safari ◽

Mohammad Amerzadeh ◽

...

Keyword(s):

Health Care ◽

Health Services ◽

Health Care Services ◽

Elderly Population ◽

The Elderly ◽

Care Needs ◽

Content Type ◽

Perceived Need ◽

Care Services ◽

Unmet Health Care Needs

Purpose The purpose of this study is to investigate the status of perceived need, seeking behavior and utilization of health services in the elderly population of Sanandaj (west of Iran). Design/methodology/approach This is a cross-sectional study conducted on 800 elderly people in Sanandaj. Subjects were selected using multistage sampling and data were collected using self-report questionnaires. A multivariate logistic model with odds ratios (ORs) was used to determine the relationship of independent variables with seeking perceived need. Also, the concentration index was used to measure the inequality in using health services. Findings The perceived need for outpatient (during the last 30 days) and inpatient health-care services (during the past 12 months) was 69.7% and 29.7%, respectively. Among them, the unmet need for outpatient and inpatient health-care services was 46.6% and 17%, respectively. Having health insurance (adjusted OR 12.08; 95% confidence interval [CI] 1.04–140.11), middle economic status (adjusted OR 5.18; 95% CI 1.30–20.51) and being in an age group of 65–70 years (adjusted OR 7.60; CI 1.42–40.61) increased the chance of seeking inpatient care. Also, being in an age group of 60–65 years (adjusted OR 0.41; 95% CI 0.18–0.95) reduced the chance of seeking outpatient care. There was also a pro-rich inequality in using outpatient health services. Originality/value The elderly population suffers from unmet health-care needs, especially in outpatient services. The most important reason for not seeking outpatient and inpatient services was financial barriers and self-medication, respectively. So, designing targeted policies and interventions to address barriers in the conversion of need to demand in the elderly population is essential.

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Primary healthcare utilization by the elderly: a secondary analysis of the 5th Indonesian Family Life Survey

Working with Older People ◽

10.1108/wwop-01-2020-0001 ◽

2020 ◽

Vol 24 (2) ◽

pp. 81-94

Author(s):

Ching-Min Chen ◽

Baithesda Baithesda

Keyword(s):

Primary Care ◽

Health Care ◽

Primary Healthcare ◽

Family Life ◽

Elderly Population ◽

The Elderly ◽

Healthcare Use ◽

Content Type ◽

Indonesian Family Life Survey ◽

Almost All

Purpose The purpose of this study is to examine different types of primary healthcare utilization and its influencing factors among the elderly in Indonesia. Design/methodology/approach Data were obtained from the 5th Indonesian Family Life Survey, a longitudinal database of demography and health information using multistage stratified sampling of households. Older adults aged at least 60 years were sampled; proxy respondents and incomplete data were excluded from the study. Findings Most of the elderly preferred to visit nurse/midwives practitioner (NP), followed by the community health centers (CHC). Those who lived outside of the Java region were more likely to visit NP; moreover, those without formal education and lived in the rural area were more likely to use CHC. Education level, region and chronic conditions were significant predicting factors for almost all types of primary healthcare use. Social implications Indonesia is moving towards an aged society in the coming decades. However, there are significant barriers to access almost all types of primary health care by the elderly in Indonesia. This shows the possibility of health care inequality for the elderly population. This study provides evidence of the various types of primary healthcare use by the elderly and its influencing factors. It hopes policymakers can use the data to develop an effective strategy to enhance the quality of primary healthcare services provides to the elderly population. Originality/value Indonesian nurses fulfill vital functions in the health system and are often the only human resource for health not only in remote and poor rural areas but also in urban areas. Nurses, as a part of primary care providers, require an adequately trained to contribute to the better primary care system.

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Molecular and Epidemiological Evidence for Spread of Multiresistant Methicillin-Susceptible Staphylococcus aureus Strains in Hospitals

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.01414-06 ◽

2007 ◽

Vol 51 (12) ◽

pp. 4342-4350 ◽

Cited By ~ 29

Author(s):

Pierre-Yves Donnio ◽

Frédéric Février ◽

Pablo Bifani ◽

Marie Dehem ◽

Christèle Kervégant ◽

...

Keyword(s):

Staphylococcus Aureus ◽

Environmental Factors ◽

Multidrug Resistant ◽

Sequence Type ◽

Molecular Characteristics ◽

Epidemiological Evidence ◽

Incidence Data ◽

Type Iv ◽

Genetic And Environmental Factors ◽

Mrsa Strains

ABSTRACT The excision of the staphylococcal chromosomal cassette mec (SCCmec) from methicillin-resistant Staphylococcus aureus (MRSA) strains results in methicillin-susceptible S. aureus (MSSA) strains. In order to determine the proportion and diversity of multidrug-resistant MSSA (MR-MSSA) strains derived from MRSA strains, 247 mecA-negative isolates recovered in 60 French hospitals between 2002 and 2004 were characterized. The spa types of all strains were determined, and a subset of the strains (n = 30) was further genotyped by multilocus sequence typing. The IDI-MRSA assay was used to test the isolates for the presence of the SCCmec element, which was detected in 68% of all isolates analyzed. Molecular analysis of the samples suggested that 92% of the MR-MSSA isolates were derived from MRSA clones of diverse genetic backgrounds, of which the clone of sequence type 8 and SCCmec type IVA accounted for most of the samples. High variations in incidence data and differences in the molecular characteristics of the isolates from one hospital to another indicate that the emergence of MR-MSSA resulted from independent SCCmec excisions from epidemic MRSA isolates, as well as the diffusion of methicillin-susceptible strains after the loss of SCCmec. MR-MSSA could constitute a useful model for the study of the respective genetic and environmental factors involved in the dissemination of S. aureus in hospitals.

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Clinical and Molecular Characteristics of Emerging Hypervirulent Klebsiella pneumoniae Bloodstream Infections in Mainland China

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.02523-14 ◽

2014 ◽

Vol 58 (9) ◽

pp. 5379-5385 ◽

Cited By ~ 69

Author(s):

Ying Mei Liu ◽

Bin Bin Li ◽

Yu Yu Zhang ◽

Wu Zhang ◽

Hong Shen ◽

...

Keyword(s):

Klebsiella Pneumoniae ◽

Clinical Features ◽

Mainland China ◽

Bloodstream Infections ◽

Molecular Characteristics ◽

Content Type ◽

Extended Spectrum Beta Lactamase ◽

Underlying Diseases ◽

Sequence Types ◽

New Alleles

ABSTRACTRecently, the newly emerged hypervirulentKlebsiella pneumoniaestrain (hvKP) has caused great concern globally, but the clinical features and molecular characteristics of bacteremia caused by hvKP are rarely reported in mainland China. Seventy patients withK. pneumoniaebacteremia were investigated to study the clinical features of hvKP infection from 2008 till 2012 in Beijing Chao-Yang Hospital. The molecular characteristics of the hvKP strains were also studied using PCR, multilocus sequence typing, and pulsed-field gel electrophoresis (PFGE) methods. hvKP was identified in 31.4% of the patients withK. pneumoniaebacteremia, which displayed 4 serotypes (K1, K2, K20, and K57). Patients with hvKP infection tended to have no underlying diseases compared to those with classicK. pneumoniae(cKP). More hvKP-positive patients (95.5%) had community-acquired infection than did cKP-infected patients (35.4%) (P< 0.001). The 30-day mortality rate was lower in hvKP-infected patients than in cKP-infected patients (4.5% compared to 16.7%). Resistance to tested antimicrobials was significantly greater in cKP- than in hvKP-infected patients. Two extended-spectrum-beta-lactamase (ESBL)-producing hvKP strains were found. Seven novel sequence types (STs) and 4 new alleles ofK. pneumoniaewere revealed. A strong correlation was found between two STs (ST23, ST1265) and the K1 serotype. The hvKP isolates (n= 22) had 14 different PFGE patterns, and among them 10 K1 isolates shared similar PFGE patterns. The emerging hvKP strain was prevalent in patients with severe community-acquired infections in healthy individuals in China. Identification of ESBL-producing hvKP strains in hvKP-infected patients will facilitate clinical management of hvKP infection.

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