Staphylococci in skin microbiocenosis of the breasts in healthy women

The autoflora of different anatomical regions of the mammary glands in 120 healthy nulliparous women aged 18-24 years was studied by P. Williamson and A. M. Kligler's methods of smears and washings. From the nipple, the areola, and the adjacent region of the skin 2,248 strains of anaerobic microorganisms were isolated; of these, 63.83% were staphylococci and micrococci, 6.01% were streptococci, 1.91% were Neisseria, 17.79% were Corynebacterium, 3.87% were bacilli, 2.8% were enterobacteria, and 3.79% were fungi. Coagulase-positive staphylococci occurred in 1.56% of cases. Out of 11 coagulase-negative species of this genus, S. epidermidis occurred most frequently on the skin of the mammary glands. The nipple was found to have the highest bacterial contamination (0.55 X 10(6) +/- 0.7 X 10(5) cells/sq. cm for the right mamma and 0.59 X 10(6) +/- 0.7 X 10(5) cells/sq. cm for the left mamma) and the skin adjacent the areola, the lowest bacterial contamination (0.14 X 10(4) +/- 0.2 X 10(3) cells/sq. cm for the right mamma and 0.25 X 10(4) +/- 0.3 X 10(3) cells/sq. cm for the left mamma). P. Williams and A. M. Kligman's method of washings, more accurate and informative, was found to be preferable for the study of the quantitative characteristics of the dermal microbiocenosis of the mammary glands.     

Staphylococci in skin microbiocenosis of the breasts in nursing women

The levels of the bacterial contamination of the nipple, the areola and the surrounding skin, the occurrence and species composition of staphylococci in 120 nursing women on days 4-5 after parturition have been studied. S. aureus contaminate the surface of the nipple and the areola in 75% of the examined women, and in 57.5% of these women the massive contamination of the above-mentioned areas (greater than or equal to 10(3) colony-forming units per sq. cm) is observed. In 80% of puerperae the occurrence of S. epidermidis on the nipple, the areola and the surrounding skin has proved to be practically the same. The population of S. aureus colonizing the mammary glands consists mainly of hospital strains; of these, 75.97% belong to phage type 75.     

Enterotoxins and phage typing of Staphylococcus aureus isolated from clinical material and food in Libya

Enterotoxin was detected in 22 (61.1%) of the 36 S. aureus strains isolated from clinical materials and in 3 (13%) of the 23 S. aureus strains from food samples (P < 0.05). On the basis of individual types of enterotoxin, staphylococcal enterotoxin A (SEA) was produced by 11.1%, SEB by 38.9% and SEC by 22.2% of SS. aureus strains from clinical material. Of the food S. aureus strains, SEC and SED produced by 8.7% and 4.3% respectively. Of the clinical and food S. aureus strains, 52.8% and 39.1%, respectively, were typeable by the 23 phages of International Phage Set. The majority of the typeable S. aureus strains from clinical and food sources belonged to group II being at 22.2% and 17.4% respectively. Furthermore, of the 14 SEB-producing S. aureus, 42.9% were of phage group II. In conclusion, the results obtained indicate that enterotoxin-producing S. aureus strains from clinical materials in Libya are not uncommon; however, certain foods appear not to be the source of such strains. Because of the low susceptibility to bacteriophages shown by S. aureus isolated in Libya, compared to reports from several countries, other methods of typing should be used in conjunction with phage typing in epidemiological investigations concerning this organism.     

Incidence of enterotoxin producing Staphylococcus aureus among pyogenic skin infections

Out of the total 68 S. aureus strains isolated and studied from pyoderma patients, 33 (48.5%) strains produced enterotoxin. Isolates from IED, impetigo and folliculitis exhibited high degree of enterotoxigenicity. SE-C and its combinations with other enterotoxins was common. 60.6% of the SE producers were found phage nontypable. Typable enterotoxigenic strains were associated with III, IV and mixed phage groups. S. aureus var. hominis and S. aureus var. bovis are the prevalent subspecies types and potent SE producers among pyogenic skin infections.     

Enterotoxin production in different Staphylococcus aureus biotypes isolated from food and meat plants.

Strains of Staphylococcus aureus isolated in Belgium and Za?re from food and from various sources in the meat industry were biotyped, phage typed and tested for staphylococcal enterotoxin (SE) production. Thirty of the 185 strains examined produced one or more SE, and 23 of these belonged to the human biotype. Most SE-positive strains belonged to phage groups III and Mixed, or were not typable. None of the poultry-like biotype strains, which were frequent in nasal carriers among workers in meat plants as well as in minced meat, produced enterotoxins. Avian biotype strains similarly were negative.     

Real-time optical detection of methicillin-resistant Staphylococcus aureus using lytic phage probes

Staphylococcus aureus (S. aureus)-specific bacteriophage was used as a probe for detection of methicillin-resistant S. aureus (MRSA) in aqueous solution using a novel optical method. Biorecognition phage monolayers transferred to glass substrates using Langmuir-Blodgett (LB) technique were exposed individually to MRSA in solution at logarithmic concentrations ranging from 10(6) to 10(9)cfu/ml, and observed for real-time binding using a CytoVivatrade mark optical light microscope system. Results indicate that LB monolayers possessed high levels of elasticity (K), measuring 22 and 29mN/m for 10(9) and 10(11)pfu/ml phage concentrations, respectively. Near-instantaneous MRSA-phage binding produced 33+/-5%, 10+/-1%, 1.1+/-0.1%, and 0.09+/-0.01% coverage of the substrate that directly correlated to a decrease in MRSA concentrations of 10(9), 10(8), 10(7), and 10(6)cfu/ml. The exclusive selectivity of phage monolayers was verified with Salmonella enterica subsp. enterica serovar typhimurium (S. typhimurium) and Bacillus subtilis.     

Enterotoxin production in different Staphylococcus aureus biotypes isolated from food and meat plants

Strains of Staphylococcus aureus isolated in Belgium and Zaïre from food and from various sources in the meat industry were biotyped, phage typed and tested for staphylococcal enterotoxin (SE) production. Thirty of the 185 strains examined produced one or more SE, and 23 of these belonged to the human biotype. Most SE-positive strains belonged to phage groups III and Mixed, or were not typable. None of the poultry-like biotype strains, which were frequent in nasal carriers among workers in meat plants as well as in minced meat, produced enterotoxins. Avian biotype strains similarly were negative.     

DNA-mediated transformation in mutants of phage group 2 Staphylococcus aureus

A large pool of antibiotic resistant and auxotrophic mutants was isolated from the Staphylococcus aureus phage group 2 strains UT0002-19 and UT0017 by (1) antibiotic gradient plates, (2) trimethoprim selection, and (3) nitrosoguanidine mutagenesis, which sometimes was coupled by enrichment with either penicillin or methicillin. Strain UT0002-19 has a chromosomal determinant for exfoliative toxin (ET), which causes "scalded skin syndrome" in man. A few mutants were isolated from the phage group 1 strain UT0080, which also produces ET. Two transformation regimens, called the broth and plate methods, were devised for the phage group 2 strains. They employed 80 alpha as helper phage, and recipient cells were incubated with transforming DNA in the presence of Ca2+. Strain UT0080 was transformed using phage 55 as helper. Maximum competence of the phage group 2 strains occurred during early logarithmic growth in trypticase soy broth, but cells grown overnight on heart infusion agar were also competent. Transformation frequencies of all markers ranged from 10(-6) to 10(-8). For phage 80 alpha, a multiplicity of infection of 4 was optimal in transforming a mutant of strain UT0002-19. Transformation of gly, lin, met, ole, rif, and ser markers in S. aureus is reported for the first time. Ery and ole markers in all three strains exhibited cross-resistance. Mapping studies, similar to those performed by DNA-mediated transformation in the phage group 3 strain 8325, can now be commenced for phage group 2 strains of S. aureus in order to elucidate the molecular genetics of this medically important bacterium.     

Production of penicillinase by staphylococcal strains of different origins

A total of 319 strains of S. aureus and 729 strains of S. epidermidis belonging to different biovars isolated from the skin and nasal mucosa of 349 persons representing 8 independent groups were tested. On the whole production of penicillinase was more often observed in the strains of S. aureus than in the strains of S. epidermidis. Within the first species this property was more often detected in the strains of biovar I as compared to the other biovars. However, the frequency of the penicillinase-producing strains within S. aureus and the biovars of S. epidermidis markedly varied.     

Characterization of Staphylococcus aureus in a Pediatric Burn Unit

A one-year study on an endemic strain of Staphylococcus aureus phage type 84/85 in a children's burn unit is described. The endemic strain rapidly colonized the burns and nares of acute patients after admission but was not isolated from a patient on admission. Nonendemic strains of S. aureus found on some new patients were mostly non-phage typable and did not prevail in burns. The endemic strain was rarely isolated from the nares and skin of reconstructive patients or from the nares of hospital personnel. The endemic strain did colonize the oral cavity, normal skin, and intestinal tract of some acute patients. Endemic and nonendemic strains of S. aureus from the burned children were compared in their biochemical activities and antibiotic sensitivities to two groups of S. aureus from one other local and one Danish burns unit. The latter groups of strains represented different combinations of staphylococcal phage group III strains. Each of the four groups of strains differed in production of hemolysins, Tween 80 hydrolysis, egg yolk reaction, and proteolysis of casein and gelatin. All of the strains were uniformly sensitive to gentamicin, oxacillin, and cephalothin. Only 4 of 162 strains tested were methicillin resistant. The endemic S. aureus strains of phage type 84/85 were uniformly resistant to eight other antibiotics including lincomycin and clindamycin. The endemic strain was not the known cause of a clinically documented infection in a group of 82 acute patients studied. The possible role of S. aureus strains of phage group III in burn grafting problems is discussed.     

A trial of the use of mupirocin in the nasal carriage of Staphylococcus aureus in medical personnel]

Many hospital-acquired purulent diseases and wound infections are due to multiresistant hospital strains of Staphylococcus aureus. The role of S. aureus nasal carriage in development of wound infections due to autoinfection is confirmed. Not only inpatients but also hospital staff can be highly colonized with coagulase positive staphylococci. The S. aureus persistence in hospital personnel results in distribution of the microorganisms in the environment. Therefore, detection of S. aureus carriers without signs of the infection among the hospital personnel and eradication of the pathogen make it possible to control outbreaks of S. aureus infection in hospitals. Clinical efficacy of nasal ointment of mupirocin in the treatment of S. aureus carriers among the intensive care personnel of the N. N.Blokhin Cancer Research Center was evaluated. S. aureus nasal carriage was diagnosed in 17 (26 per cent) out of 65 persons. All the isolates were susceptible to oxacillin. 5-7 days after discontinuation of the mupirocin nasal ointment use eradication of S. aureus was stated in 100 per cent of the cases. The effect was still observed in 94 per cent of the cases in 1 month, in 76 per cent of the cases in 5-6 months and in 60 per cent of the cases in 8-9 months. It is believed that mupirocin nasal ointment (Bactroban) is convenient to use, low toxic and highly active in the treatment of persons with S. aureus nasal carriage.     

Serotyping of Dutch Staphylococcus aureus strains from carriage and infection

International epidemiological studies have shown that clinical isolates of Staphylococcus aureus are usually capsulated with either type 5 or 8 capsular polysaccharides (CPs). Because all noncapsulated strains were found to be cross-reactive with polysaccharide 336 (336PS) antibodies, the noncapsulated strains were denoted as type 336PS. The capsular types of 162 Dutch methicillin-susceptible S. aureus strains derived from individuals living in the Rotterdam area were determined. The serotype distribution was 28.4% serotype 5, 53.7% type 8, and 17.9% type 336PS. Serotyping was in agreement with genotyping by amplified fragment length polymorphism (AFLP) and multi locus sequence typing (MLST). Among 49 nasal carriage isolates from healthy children 24.5% belonged to serotype 5, 67.3% were type 8 and 8.2% were type 336PS. For 28 adult patients on chronic ambulatory peritoneal dialysis (CAPD) the serotype incidences among carriage isolates obtained from the nose, catheter exit-site, and abdominal skin were 45.1%, 41.2% and 13.7%, respectively. Among S. aureus strains deriving from blood cultures, the serotype incidences were 17.7% serotype 5, 53.2% type 8, and 29.0% type 336PS. Apparently, type 336PS strains are more prevalent (P=0.017) among bacteraemia isolates as compared with the nasal carriage isolates obtained from healthy children and CAPD patients. In conclusion, all Dutch S. aureus isolates belonged to types 5, 8, or 336PS, which is in agreement with data from other countries. Thus, addition of the 336PS conjugate to a type 5- and type 8-CP protein conjugate vaccine would significantly extend the vaccine coverage.     

Disappearance of differences in antibiotic resistance of Staphylococcus aureus strains isolated in hospitals and in general practice

There is general opinion that Staphylococcus aureus strains isolated in hospitals are more frequently resistant to antibiotics than community strains, however, the increasing resemblance between hospital and community strains has been recently reported. The aim of the study was to compare the antibiotic resistance and phage-type pattern of S. aureus strains isolated from patients treated either in hospitals or in general practice in northern part of Poland. The study was conducted on 771 S. aureus strains isolated from different specimens. Phage typing was performed according to the method of Blair and Williams. The drug susceptibility was determined by the disc-diffusion method. There were no significant differences in antibiotic resistance or phage-type pattern when hospital and community methicillin-sensitive S. aureus (MSSA) strains were compared. The most MSSA were resistant to penicillin (84.6% and 82.1% respectively) and doxycycline (49.3% and 50.4% respectively) whereas they were rarely resistant to other antibiotics. The predominance of phage group II was found in both hospitals (28.0%) and general practice (29.9%). Phage group III, usually associated with hospitals, occurred in small percentage (12.9% and 9.4% respectively) while to this group predominantly (76.6%) multiresistant methicillin resistant S. aureus (MRSA) isolated in hospitals belonged. These results suggest, that there is only slight difference in antibiotic resistance between hospital and community S. aureus strains. Antibiotic resistance pattern mainly results from frequency of appearance of MRSA, mostly occurring in hospitals.     

Comparative Characterization and Biotyping of Staphylococcus aureus Isolates from Human and Bovine Sources

One Hundred and ten alpha and/or delta-haemolytic isolates (collection 1), 50 beta haemolytic isolates (collection 2) from bovine mastitis, and 100 previously phage-typed alpha- and delta-haemolytic isolates (human collection) og Staphylococcus aureus (S. aureus) were tested and biotyped according to the scheme of Hajek & Marsalek (1971). Among collection 1 isolates, 85 (77.3 %) belonged to the human biotype A (human source). Twenty two (20 %) designated as non-allotted strains, possessed characteristics of both animal and human sources. The remaining 3 isolates (2.7 %) in this collection belonged to biotype C (animal source). All collection 2 isolates which were used as control strains for animal sources, belonged to biotype C. The human collection that contained 100 phage-typed haemolytic isolates (representing all human phage groups) were used as a control for the human source. Irrespective of their phage group, these strains predominantly produced alpha and/or delta haemolysins and belonged to the human biotype A. This study also recommended the use of a combined plasma crystal violet agar medium for the presumptive identification of S. aureus biotypes.     

Potential of the polyvalent anti-Staphylococcus bacteriophage K for control of antibiotic-resistant staphylococci from hospitals

The increasing prevalence of antibiotic-resistant staphylococci has prompted the need for antibacterial controls other than antibiotics. In this study, a lytic bacteriophage (phage K) was assessed in vitro for its ability to inhibit emerging drug-resistant Staphylococcus aureus strains from hospitals and other species of Staphylococcus isolated from bovine infections. In in vitro inhibitory assays, phage K lysed a range of clinically isolated methicillin-resistant S. aureus (MRSA) strains, S. aureus with heterogeneous vancomycin resistance and vancomycin resistance, and teicoplanin-resistant strains. In these assays, 14 of the MRSA strains were initially only weakly sensitive to this phage. However, propagation of phage K on these less-sensitive strains resulted in all 14 being sensitive to the modified phages. The results enforce the principle that, while certain target bacteria may be relatively insensitive to lytic phage, this can be overcome by obtaining modified phage variants from passage of the phage through the insensitive strains. Model in situ hand wash studies using a phage-enriched wash solution resulted in a 100-fold reduction in staphylococcal numbers on human skin by comparison with numbers remaining after washing in phage-free solution. Infusion of the phage into a nonimmunogenic bismuth-based cream resulted in strong anti-Staphylococcus activity from the cream on plates and in broth.     

Characterization of the bacteriophage B2 of Lactobacillus plantarum ATCC 8014

Bacteriophage B2 of Lactobacillus plantarum ATCC 8014, isolated in 1971, belonged to Bradley's group B. Electron microscopy revealed an isometric head (110 nm) and a long non-contractile and flexible tail (500 nm) containing about 75 regularly aligned lateral striations. Burst size was 12-14 phages per infectious centre. The latent period for phage development was 75 min and the rise period approximately 90 min. The phage particle contained 5 major proteins. The buoyant density of the phage in CsCl was measured as 1.575 g/cm3. B2 genome was a linear double-stranded DNA molecule of 37 +/- 1% guanosine-cytosine. Its size was 73 kilobase pairs (kbp). Restriction analysis of the genome showed that 4 restriction enzymes (Xba I, Sac I, Bgl II and Sma I) gave single site cuts in the DNA, while Ava I and Sal I formed 2 and 5 cuts, respectively.     

Classification and biological characteristics of coagulase-positive Staphylococci isolated from animals

A total of 165 coagulase-positive staphylococcal strains of different origin (142 S. aureus strains and 23 S. intermedius strains) were subjected to biological typing in accordance with the schemes of Hajek-Marsalek and Meyer-Witte. The former of these schemes permitted to identify 68% and the latter 18% of S. aureus strains. The cultures isolated from swine and chickens had the most uniform composition: 85-86% of the strains belonged to biotype B. 44% of the strains isolated from cows and sheep belonged to biotypes C (ecovars bovis and ovis) and A (ecovar hominis); the rest of the strains could not be identified. 96% of the strains isolated from minks were made up of S. intermedius, more than a half of them belonging to biotype E (ecovar canis). In 80% of S. aureus strains and 48% S. intermedius cultures protein A was detected. Only 9% of S. aureus strains of animal origin were found capable of producing enterotoxins (A-D). The expediency of working out a unified scheme for the biotyping of coagulase-positive staphylococci is discussed.     

Dynamics of the types of carrier state and their relationship to the phage group characteristics of pathogenic staphylococci]

A total of 305 persons belonging to the medical staff of a hospital surgery unit were subjected to multiple examinations during period of up to 8 years. 2,354 staphylococcal strains isolated from these subjects were studied, and the following types of carrier state were determined: constant (23.6 +/- 2.43%), intermittent (57.4 +/- 2.83%), resident (7.9 +/- 1.54%), and the stable absence of carrier state (11.1 +/- 1.60%). An increase in the number of examinations and the terms of observation resulted in a regular increase in the number of intermittent carriers at the expense of constant carriers and persons not identified as carriers. Against this background resident carriers constituted a relatively more stable group. Carrier states of the resident type were connected with staphyloccci belonging to various phage groups without pronounced differences in the frequency with which any of the phage groups occurred.     

Features of contamination of the environment by Staphylococcus aureus carriers

The specific features of the spread of S. aureus from carriers indoors were studied. In this study S. aureus cells were most frequently isolated from the floor, less frequently from the walls and furniture and even less frequently from the air. S. aureus were detected on environmental objects as early as 30 minutes after the carrier stayed and breathed in the room. The contamination of environmental objects increased when the carrier spoke loudly and made such respiratory acts as coughing and sneezing. After the carrier left the room the contamination of the environmental objects persisted for at least 14 hours (the term of observation), gradually decreasing. The degree of the contamination of environmental objects was inversely related to the distance of these objects from the carrier. The contamination of the environment was shown to be directly related to the concentration of S. aureus in the nasal cavity of carriers.     

Host-microbe interplay in persistent Staphylococcus aureus nasal carriage in HIV patients

It has been shown that persistent Staphylococcus aureus nasal carriage results in increased bacterial dispersal and a higher risk of infection compared to non-or-intermittent S. aureus carriage. Although many studies investigated S. aureus nasal carriage in HIV patients, none compared persistent carriage to non-persistent carriage nor were studies performed in the HAART era. We investigated the host-microbe interplay of persistent S. aureus nasal carriage in HIV-infected patients by studying host determinants of persistent carriage as well as the genetic structure of S. aureus strains isolated. We compared this genetic structure with the previously determined population structure of S. aureus isolates obtained from healthy individuals. Between February 2004 and June 2005 all HIV patients visiting the outpatient department of Erasmus MC (Rotterdam, The Netherlands) were asked to participate in this study. Participants were interviewed and screened for persistent S. aureus carriage using two semi-quantitative nasal swab cultures. For 443 patients two cultures were available, 131 (29.6%) were persistent carriers, which is significantly higher as compared to healthy individuals from the same geographic region (17.6%; P<0.0001). Male sex (odds ratio [OR], 2.22; 95% confidence interval [CI], 1.32-3.73), current smoking (OR, 0.58; 95% CI, 0.38-0.90), Pneumocystis jiroveci pneumonia (PCP) prophylaxis (OR, 0.39; 95% CI, 0.16-0.97) and antiretroviral therapy (OR, 0.61; 95% CI, 0.38-0.98) were independent determinants of persistent carriage. Only two strains were mecA positive (1.2%) and no PVL positive strains were detected. The population structure of S. aureus strains isolated from HIV patients appeared to be strongly overlapping with that of S. aureus isolates from healthy individuals.