Clinical Spectrum and Resistance Profile of Staphylococcus Infections in a Peri Urban Tertiary Care Hospital

Staphylococcus may be evaluated to be a serious microorganism to colonizes and contaminate both the healthy and immuno-competent people in the community along with the hospitalized patients with decreased immunity. This bacterium has been commonly present on the skin and in the nasal cavity of the human body. In the particular sites the organisms may give rise to local diseases of the nose, urethra, vagina and gastrointestinal tract, skin however most of them are minor and not associated with any mortality. S. aureus as well as coagulase-negative staphylococcus which are gram-positive bacteria that lives on the upper respiratory, mouth and skin structure creation, are the possible element for nosocomial and opportunistic disease in humans as well as in animals. Major complications involved with staphylococcus involved SSI, bullous impetigo, skin & soft tissues infection, bacteremia, pulmonary infections etc. The situation is further complicated by methicillin resistance in staphylococcus. MRSA/MRCoNS are considered as the emerging cause of hospital-acquired infections. it is very necessary to quantify the load of infections in order to achieve good hospital infection control policies. Furthermore, the morbidity and mortality rate may also be reduced in the same manner.

Phylogenomic study of Staphylococcus aureus and Staphylococcus haemolyticus clinical isolates from Egypt

Antibiotic resistant Staphylococcus infections are a global concern, with increasing cases of resistant Staphylococcus aureus and Staphylococcus haemolyticus found circulating in the Middle East. While extensive surveys have described the prevalence of resistant infections in Europe, Asia, and North America, the population structure of resistant staphylococcal Middle Eastern clinical isolates is poorly characterized. We performed whole genome sequencing of 56 S. aureus and 10 S. haemolyticus isolates from Alexandria Main University Hospital. Supplemented with additional publicly available genomes from the region (34 S. aureus and 6 S. haemolyticus), we present the largest genomic study of staphylococcal Middle Eastern isolates. These genomes include 20 S. aureus multilocus sequence typing (MLST) types and 9 S. haemolyticus MLSTs, including 3 and 1 new MLSTs, respectively. Phylogenomic analyses of each species core genome largely mirrored MLSTs, irrespective of geographical origin. The hospital-acquired spa t037/SCCmec III/MLST CC8 clone represented the largest clade, comprising 22% of S. aureus isolates. Similar to other regional genome surveys of S. aureus, the Middle Eastern isolates have an open pangenome, a strong indicator of gene exchange of virulence factors and antibiotic resistance genes with other reservoirs. We recommend stricter implementation of antibiotic stewardship and infection control plans in the region.

Treating osteoarticular infections in a Role 2 in Chad: a bacterial epidemiological study

IntroductionThe treatment of osteoarticular infections in Africa is a medical and surgical challenge due to the difficulties in managing antibiotic therapy after the surgical procedure. The objectives of this study were to identify the types of bacteria in osteoarticular lesions in patients treated in Chad and to determine the spectrum of resistance encountered and the efficacy of available antibiotics.Material and methodsThis is a retrospective study of all intraoperative osteoarticular and soft tissue samples taken in a French Role 2 Medical Treatment Facility of N'Djamena during surgery for chronic osteoarticular infections, in Chad, for 1 year.ResultsA total of 160 bacterial strains were identified, with a predominance of Gram-negative bacillus (GNB) and staphylococcus infections. Among staphylococci, 80% were methicillin-sensitive streptococci which were generally multidrug-sensitive. Enterococci were resistant to third-generation cephalosporins, first-generation fluoroquinolones and gentamycin. Among GNB, there was a predominance of enterobacteria compared with non-fermenting GNB, of which 52% were multidrug-resistant and produced extended spectrum beta-lactamases (ESBL).ConclusionStaphylococcus aureus infections are most often sensitive to available antibiotics and therefore have better prognoses than infections caused by other bacteria. In contrast, in half of the cases of GNB, infections were caused by bacteria producing ESBL, thus posing the problem of multidrug-resistance, the risks of which are increased in precarious situations. Therefore, the type of bacteria appears to be a major prognostic factor in the treatment of osteoarticular infections in a Role 2 in Chad. This criterion will need to be considered before any treatment decisions are made.

Abstract 13604: Virulence of Staphylococcus Infection in Surgically Treated Patients With Endocarditis - A Multi-center Analysis

Introduction: Infective endocarditis (IE) caused by Staphylococcus species have been noted to increase and are believed to be associated with higher morbidity and mortality rates. Hypothesis: Staphylococcus species are more virulent compared to other commonly causative bacteria of IE. Methods: The database of the Clinical Multicenter Project for Analysis of Infective Endocarditis in Germany (CAMPAIGN), comprising 4917 consecutive patients (mean age 62.2±14.6 years) undergoing heart valve surgery, was retrospectively analyzed. Uni- and multivariable regression analyses were used for comparison and risk stratification. The Kaplan Meier method was used for long-term survival estimation of the respective groups. Results: Staphylococcus patients (n=1260) were significantly more morbid than the Non-Staphylocccus group (n=3657) with regard to NYHA IV (21.4% vs. 16.7%*), CAD (29.0% vs. 25.7%; p =0.027), arterial hypertension (64.8% vs. 45.8%*), diabetes (29.9% vs. 24.8%*), renal failure (47.5% vs. 35.2%*), COPD (12.8% vs. 9.9%; p =0.007), PAD (11.3% vs. 6.4%*), preoperative stroke (35.1% vs. 18.0%*) and need for mechanical ventilation (18.2% vs. 6.4%*). Overall, Staphylococcus infections were more prevalent on mitral (51.0% vs. 42.0%*) and tricuspid (9.4% vs. 4.4%*) valves and showed higher incidences of large vegetations (87.0% vs. 56.0%*), mitral regurgitation (62.5% vs. 41.5%*) and preoperative septic embolism (51.8% vs. 28.9%*). Postoperatively, need for tracheostomy (13.7% vs. 7.6%*) and dialysis (29.4% vs. 13.6%*) were also significantly increased. The 30-day mortality for Staphylococcus was significantly higher (21.3% vs. 15.9%*) and long-term survival was significantly worse ( Fig. 1 ). Conclusions: Staphylococcus endocarditis is associated with significantly worse outcome compared to IE by other commonly causative bacteria. Early surgery should be considered to avoid preoperative septic embolism, deterioration and death. *= p <0.0001

Hyper IgE syndrome (Job syndrome) in Syria: a case report

ABSTRACT Hyper IgE syndrome (HIES) is a medical condition that can be sporadic or hereditary. It consists of multiple overlapping primary immunodeficiency conditions and is characterized by a classical triad of high immunoglobulin E (IgE) levels, recurrent pneumonia with pneumatocele and recurrent cold skin abscesses from staphylococcus infections. Eosinophilia is also common in HIES patients. HIES is often underdiagnosed in Syria as it cannot be confirmed without genetic testing, which is unavailable across Syria for HIES. We present the first case from Syria of a suspected child with HIES that has some additional distinct features. Other cases in a regional country carried atypical novel mutations, which may indicate that these mutations may exist in Syria as well. However, our case had findings that were not reported with other HIES cases. Determining these genes in the case presented was not possible, and future studies need to overcome this hurdle.

Infective endocarditis in patients with solid organ transplantation. A nationwide study

Background An increase in nosocomial and health care-related infective endocarditis (IE) has been described. Solid organ transplantation (SOT) implies immunosuppression and frequent health care contact. Our aim was to compare characteristics of patients with IE and SOT against those without SOT. Methods We used data from the Spanish Collaboration on Endocarditis obtained during the period 2008–2018. Results We identified 4794 cases of IE, 85 (1.8%) in SOT (56 kidney, 18 liver, 8 heart, 3 lung). Thirteen patients had other types of transplantation (bone marrow, hematopoietic precursors, and cornea) and were excluded from the analysis. Compared with patients without SOT, patients with SOT had a higher median age (69 vs. 61 years, p&lt;0.001), more comorbidities (mean age-adjusted Charlson index 5.7±2.9 vs. 4.9±2.9, p=0.004), a lower prevalence of native valvular heart disease (29.4 vs. 45.4%, p=0.003), more in-hospital and healthcare-related IE (70.5% vs. 36.3%, p&lt;0.001) and Staphylococcus etiology (57.7% vs. 39.7%, p=0.001). Regarding evolution, patients with SOT had more frequent kidney function worsening (47.1% vs. 34.6%, p=0.02), septic shock (25.9% vs. 12.1%, p&lt;0.001), sepsis (27.1% vs. 17.2%, p=0.02). Surgery indication (54.1% vs 66.3%, p=0.02) and surgery (32.9% vs. 46.3%, p=0.01) were less frequent in patients with SOT. We were unable to find significant differences in mortality: inhospital (30.6% vs. 25.6%, p=0.31), 1-year (38.8% vs. 31.9%, p=0.18). Conclusion IE in SOT patients has specific characteristics. Most of the cases are nosocomial and over 70% are hospital-or health care-related. Half have previously normal heart valves and almost 60% are due to Staphylococcus infections. Figure 1. Kaplan Meier survival curves for patients with and without solid organ transplantation (SOT). SOT: 56 kidney, 18 liver (2 combined with kidney), 8 heart, 3 lung. Funding Acknowledgement Type of funding source: None

The Resistance of Staphylococcus Species to Different Antibiotics in Al-Kharj City

Introduction: Infections caused by Staphylococcus species can spread not only in hospitals but also in the community and in other healthcare institutions. These organisms were known for its capability to acquire resistance to various classes of antibiotics. Methods: The antibiotic susceptibility and resistance rates of S. aureus strains isolated from numerous clinical samples at a public hospital in Al-kharj city were collected from the monthly antibiogram prepared by the laboratory department in the hospital. Results: The bacterial culture results found that there were 450 Staphylococcus species; the majority of bacteria were Staphylococcus aureus. Some medications such as Vancomycin, Linezolid still very effective in treating Staphylococcus infections. Conclusion: S. aureus infections were common in Alkharj city and the resistance is widespread for staphylococci species, mainly MRSA. To reduce the resistance rate antimicrobial stewardship programs should be implemented and antibiotic susceptibility should be monitored continuously.

Clinicopathologic Features of Infection-Related Glomerulonephritis with IgA Deposits: a French Nationwide Study

Background: Infection-related glomerulonephritis with IgA deposits (IRGN-IgA) is a rare disease but it is increasingly reported in the literature. Data regarding epidemiology and outcome are lacking, especially in Europe. We aimed to assess the clinical, pathologic and outcome data of IRGN-IgA. Methods: Clinical and outcome data from patients from 11 French centers over the 2007-2017 period were collected retrospectively. We reviewed pathologic patterns and immunofluorescence of renal biopsies and evaluated C4d expression in IRGN-IgA. We analyzed the correlation between histological presentation and outcome. Results: Twenty-seven patients (23 men, mean age: 62±15 years) were included. Twenty-one (78%) had Staphylococcus aureus infection and twelve (44%) were diabetic. At the time of biopsy, 95.2% had haematuria, 48.1% had a serum creatinine level of >4 mg/dL, and 16% had hypocomplementemia. The most common pathologic presentation included mesangial (88.9%) and endocapillary proliferative glomerulonephritis (88.9%) with interstitial fibrosis and tubular atrophy (IF/TA) (85.1%). Diffuse and global glomerular C4d expression was found in 17.8%, mostly in biopsies with acute or subacute patterns, and was associated with a short delay between infection and renal biopsy compared to segmental and focal staining. After median follow-up of 13.2 months, 23.1% died, 46.2% had persistent renal dysfunction and 15.4% reached end-stage renal disease. Renal outcome was correlated to IF/TA severity. Conclusions: Infection-related glomerulonephritis with IgA deposits is usually associated with Staphylococcus infections and mainly affects adult men. This entity has a poor prognosis which is correlated to interstitial fibrosis and tubular atrophy severity.

Loss of daptomycin susceptibility in clinical Staphylococcus epidermidis infection coincided with variants in WalK

Daptomycin (DAP) is key in treating multidrug-resistant Staphylococcus infections. Diminished susceptibility to DAP is emerging among Staphylococcus epidermidis strains although mechanisms for non-susceptibility (NS) remain poorly understood. We report a case of persistent S. epidermidis bacteremia in which loss of DAP susceptibility arose during prolonged treatment. Whole genome sequencing identified two mutations, Q371del and P415L, in a single-affected gene, WalK, that coincided with the emergence of DAP-NS. Protein modeling of the mutations predicted a disruption of WalK protein configuration. The emergence of mutations in a single-gene during DAP exposure raises concerns in an era of increasingly treatment-resistant infections. Lay summary: Daptomycin is an important antibiotic for fighting Staphylococcus infections. We identified variants in the WalK gene that were coincident with resistance in a clinical Staphylococcus epidermidis infection. Clinicians, hospital epidemiologists, and microbiology laboratories need to be aware of the potential for the evolution of drug resistance during prolonged daptomycin therapy.