Molecular Typing of MRSA and of Clinical Staphylococcus aureus Isolates from Ia?i,Romania

Romania is one of the countries with the highest prevalence of methicillin-resistant Staphylococcus aureus (MRSA) in the world. To obtain data on affiliation of MRSA to strains and clonal complexes and on the population of methicillin susceptible S. aureus (MSSA), clinical isolates from bloodstream infections, skin and soft tissue infections as well as from screening swabs were collected at hospitals in Ia?i, a city in the North-Eastern part of Romania. Isolates were characterised by microarray hybridisation. Nearly half of all isolates (47%), and about one third (34%) of bloodstream isolates were MRSA. The prevalence of the Panton-Valentine leukocidin (PVL) was also high (31% among MRSA, 14% among MSSA). The most common MRSA strain was a PVL-negative CC1-MRSA-IV that might have emerged locally, as a related MSSA was also common. PVL-positive CC8-MRSA-IV (“USA300”) and PVL-negative ST239-like MRSA-III were also frequently found while other MRSA strains were only sporadically detected. Among MSSA, PVL-positive CC121 as well as PVL-negative CC1, CC22 and CC45 predominated. Although this study provides only a snapshot of S. aureus/MRSA epidemiology in Romania, it confirms the high burden of MRSA and PVL on Romanian healthcare settings.     

Successful eradication of methicillin-resistantStaphylococcus aureus (MRSA) intestinal carrier status in a healthcare worker — Case report

We describe bacteriophage therapy in the case of a healthcare worker whose gastrointestinal tract was colonized by methicillin-resistant Staphylococcus aureus (MRSA) with subsequent urinary tract infection caused by the same pathogen. Oral treatment with anti-MRSA phages resulted in eradication of the carrier status.     

Methicillin-resistant Staphylococcus aureus (MRSA) with high resistance to mupirocin in hospitals of the Gdańsk region

Occurrence of high-level mupirocin resistance in methicillin-resistant Staphylococcus aureus (MRSA) strains isolated from 18 hospitals in Gdańsk area was determined. The study was carried out on 190 MRSA isolated in 1997-2000 from various clinical samples. The strains were tested for high-level mupirocin resistance by 200 micrograms mupirocin disc. The minimum inhibitory concentrations (MIC) for methicillin were estimated by agar dilution. Sensitivity to other antibiotics was determined in disc-diffusion method and to vancomycin in agar dilution method additionally. The strains were typed by set of 10 experimental phages and compared by the method of PCR-RFLP analysis of coagulase gen restriction fragment length polymorphism. There were low frequency of high-level mupirocin resistance in MRSA strains (4.7%) that were found only in 3 hospitals, in 6 patients. All of them were high-resistant also to methicillin and resistant to doxycyclin, gentamycin, erytromycin, klindamycin, ciprofloksacin, rifampicin, resistant or intermediate sensitive to fusidic acid but sensitive to vancomycin, teikoplanin and bacitracin. The origin all of the MRSA strains high-resistant to mupirocin probably was the same, except one strain, because they were belonged to one genetic type and possessed the same phage pattern.     

Sepicanin A—A new geranyl flavanone from Artocarpus sepicanus with activity against methicillin-resistant Staphylococcus aureus (MRSA)

Bioassay-guided fractionation of the EtOH extract of Artocarpus sepicanus Diels leaves has led to the isolation of a new geranyl flavanone (1), along with the known compounds, afzelechin-3-O-α-l-rhamnopyranoside and β-sitosterol glucoside. The structure of the new compound was established by UV, IR, HRESIMS, 1D and 2D NMR experiments. Antimicrobial testing of the three compounds indicated that 1 displayed a significant selective antibacterial activity against methicillin-resistant Staphylococcus aureus (MRSA) with IC₅₀ and MIC values of 1.4 and 2.9 μM, respectively.     

MRSA筛检培养基的研究进展

自从1961年英国学者JEVONS首次报道耐甲氧西林金黄色葡萄球菌（methicillin-resistant Staphylococcus aureus,MR-SA）以来,MRSA感染日益增多,现已成为全球医院感染和社区获得性感染的重要病原菌之一。MRSA具有多重耐药性,且近年已有万古霉素敏感性减低或耐药菌株的报道;     

Healthcare-associated (HA) and community-associated (CA) methicillin resistant Staphylococcus aureus (MRSA) in Bangladesh – Source,diagnosis and treatment

Methicillin-resistant Staphylococcus aureus (MRSA) has long been a common pathogen in healthcare facilities, but now, it has emerged as a problematic pathogen in the community setting as well. This study reported source, diagnosis and treatment of HA-MRSA and CA-MRSA.A total of sixty-five clinical samples (urine, pus, wound swab) were collected from clinical origin of Dhaka city, Bangladesh. All the isolates were tested phenotypically by conventional methods and genotypically by PCR targeting nuc, pvl and mecA genes. Finally sequencing was carried out for pvl gene to know the mutagenic variation or any amino acid changes in pvl gene. Chi square test was employed for statistical analysis. Patients of age group 51–60?years are more susceptible (46.15%) to MRSA, CA-MRSA or HA-MRSA infection. Female are (32.30%) more susceptible to MRSA infection. Among 65 isolates 53 isolates identified phenotypically as S. aureus. These were positive for amplification of nuc (270?bp) gene of S. aureus. Moreover, among 53 isolates 33 phenotypically considered as MRSA and 38 (72%) showed positive amplification for mecA (162?bp) gene. Among 38 MRSA isolates 22 (57.89%) confirmed as CA-MRSA and 16 (42.10%) as HA-MRSA. Finally, sequence analysis for lukS/F-PV genes from 4 representative isolates detected a new single nucleotide polymorphism in comparison with the control sequence. However, no amino acid changes were found. Statistical analysis showed HA-MRSA isolates were more commonly found in urine sample and CA-MRSA in pus and wound swab. CA-MRSA isolates were more resistant to tested antibiotics than HA-MRSA.     

How clonal is Staphylococcus aureus?

Staphylococcus aureus is an important human pathogen and represents a growing public health burden owing to the emergence and spread of antibiotic-resistant clones, particularly within the hospital environment. Despite this, basic questions about the evolution and population biology of the species, particularly with regard to the extent and impact of homologous recombination, remain unanswered. We address these issues through an analysis of sequence data obtained from the characterization by multilocus sequence typing (MLST) of 334 isolates of S. aureus, recovered from a well-defined population, over a limited time span. We find no significant differences in the distribution of multilocus genotypes between strains isolated from carriers and those from patients with invasive disease; there is, therefore, no evidence from MLST data, which index variation within the stable "core" genome, for the existence of hypervirulent clones of this pathogen. Examination of the sequence changes at MLST loci during clonal diversification shows that point mutations give rise to new alleles at least 15-fold more frequently than does recombination. This contrasts with the naturally transformable species Neisseria meningitidis and Streptococcus pneumoniae, in which alleles change between 5- and 10-fold more frequently by recombination than by mutation. However, phylogenetic analysis suggests that homologous recombination does contribute toward the evolution of this species over the long term. Finally, we note a striking excess of nonsynonymous substitutions in comparisons between isolates belonging to the same clonal complex compared to isolates belonging to different clonal complexes, suggesting that the removal of deleterious mutations by purifying selection may be relatively slow.     

MRSA感染抗菌药物治疗

ＭＲＳＡ感染抗菌药物治疗解放军总医院北京临床药物药理研究室北京１００８５３王睿（综述）周贵民（审阅）随着抗菌药物广泛应用,细菌耐药性不断增强。近年来耐甲氧西林金黄色葡萄球菌（ｍｅｔｈｉｃｉｌｉｎ－ｒｅｓｉｓｔａｎｔｓｔａｐｈｙｌｏｃ－ｏｃｃｕｓａｕｒ...     

Optimization and structure–activity relationships of a series of potent inhibitors of methicillin-resistant Staphylococcus aureus (MRSA) pyruvate kinase as novel antimicrobial agents

A novel series of hydrazones were synthesized and evaluated as inhibitors of methicillin-resistant Staphylococcus aureus (MRSA) pyruvate kinase (PK). PK has been identified as one of the most highly connected ‘hub proteins’ in MRSA. PK has been shown to be critical for bacterial survival which makes it a potential target for development of novel antibiotics and the high degree of connectivity implies it should be very sensitive to mutations and thus less able to develop resistance. PK is not unique to bacteria and thus a critical requirement for such a PK inhibitor would be that it does not inhibit the homologous human enzyme(s) at therapeutic concentrations. Several MRSA PK inhibitors (including 8d) were identified using in silico screening combined with enzyme assays and were found to be selective for bacterial enzyme compared to four human PK isoforms (M1, M2, R and L). However these lead compounds did not show significant inhibitory activity for MRSA growth presumably due to poor bacterial cell penetration. Structure–activity relationship (SAR) studies were carried out on 8d and led us to discover more potent compounds with enzyme inhibiting activities in the low nanomolar range and some were found to effectively inhibit bacteria growth in culture with minimum inhibitory concentrations (MIC) as low as 1 μg/mL. These inhibitors bind in two elongated flat clefts found at the minor interfaces in the homo-tetrameric enzyme complex and the observed SAR is in keeping with the size and electronic constraints of these binding sites. Access to the corresponding sites in the human enzyme is blocked.     

MRSA感染性创面菌群结构分析

目的探究耐甲氧西林金黄色葡萄球菌(MRSA)感染性创面与创面旁菌种组成的差异并寻找可能的有益菌,为从皮肤微生态角度治疗MRSA感染性创面提供理论依据。方法采集湖南省人民医院MRSA感染性创面及创面旁的皮肤样本,其中创面部位样本22份为D组,创面旁样本11份为N组,提取样本DNA,采用高通量测序技术对16S rRNA基因V3-V4区测序并进行生物信息学分析。结果根据Alpha多样性分析,D组的Chao1指数、Ace指数和Shannon指数明显低于N组(Z=62, P=0.023 8；Z=66, P=0.035 9；Z=30, P=0.000 2),而Simpson指数明显高于N组(Z=211, P=0.000 3)。Beta多样性分析显示2组皮肤菌群组成具有差异,表明分组合理(R=0.584 3、0.467 3, P=0.001 0)。D组葡萄球菌属(Staphylococcus)及韦荣球菌属(Veillonella)丰度显著性升高(Z=213, P=0.000 5；Z=48.5, P=0.004 8),其他常驻菌群均下降。N组的乳杆菌属(Lactobacillus)相对丰度均值较D组高(Z=38, P=0.000 8)。结论MRSA感染性创面的菌群结构较创面旁组具有一定变化,Lactobacillus为皮肤有益菌,可能对创面的恢复有益。     

MRSA和MRCNS院内分布调查

对１６３７ 人（ 件） 次医、护人员手及护理工作台和病房床头桌进行了金黄色葡萄球菌（ＳＡ） 、凝固酶阴性葡萄球菌（ＣＮＳ） 、耐甲氧苯青霉素金黄色葡萄球菌（ ＭＲＳＡ） 及耐甲氧苯青霉素凝固酶阴性葡萄球菌（ ＭＲＣＮＳ） 的分布调查。结果表明,四种标本上ＳＡ 携带率分别为４．５ ％ 、３．１ ％ 、３．０ ％ 和６．１ ％ ;ＣＮＳ 携带率分别是３１．３ ％ 、３７．７ ％ 、３７．６ ％ 和４３．４ ％ 。而四种标本上ＭＲＳＡ 占检出ＳＡ 的百分率分别是２６．２ ％ 、２４．３ ％ 、２３．０ ％ 、３１．８ ％ ;ＭＲＣＮＳ占检出ＣＮＳ的百分率分别是２８．１ ％ 、２７．６ ％ 、２２．０ ％ 、３４．８ ％ 。所检出的ＭＲＳＡ 和ＭＲＣＮＳ对１４ 种抗生素的耐药性较ＳＡ 和ＣＮＳ都高。鉴于ＭＲＳＡ 和ＭＲＣＮＳ在医院环境中的分布,注意医护人员手及工作环境的清洁和消毒,是切断该类菌交叉感染的有效途径。     

Are all MRSA made equal?

The health and economic burden of methicillin-resistant Staphylococcus aureus (MRSA) in the medical realm is considerable. Although there is ample clinical and laboratory evidence indicating that methicillin-susceptible S. aureus (MSSA) is heterogeneous in disease causation, the same heterogeneity has not been well documented for MRSA. Data from animal models and human studies suggest that MRSA is at least as pathogenic as MSSA. Many comparative clinical studies, mainly retrospective, have assessed the virulence of MSSA and MRSA. Whereas the majority of these studies may be deficient in some aspects of clinical design, there has been a definite trend towards implicating MRSA as the more aggressive pathogen. Such an observation, however, must be tempered with the fact that few such studies have attempted to establish clonality among MRSA isolates. Thus, it is conceivable that hypervirulent clones may represent an important proportion of MRSA from hospital studies where patient-patient spread is likely and, accordingly, comparative studies may be biased. Future clinical studies should be prospective and should use well-defined and homogeneous patient groups. As well, for comparison of MRSA and MSSA, an understanding of clonality is essential.     

How does Staphylococcus aureus escape the bloodstream?

Staphylococcus aureus is a major cause of bacteraemia, which frequently leads to infective endocarditis, osteomyelitis, septic arthritis and metastatic abscess formation. The development of these secondary infections is due to bacterial dissemination from the blood into surrounding tissues and is associated with significantly increased morbidity and mortality. Despite the importance of S. aureus extravasation in disease progression, there is relatively little understanding of the molecular mechanisms by which this pathogen crosses the endothelial barrier and establishes new sites of infection. Recent work has identified a number of putative routes by which S. aureus can escape the bloodstream. In this article we review these new developments and set them in the context of strategies used by other established pathogens to traverse cellular barriers.     

Staphylococcus aureus: superbug, super genome?

Staphylococcus aureus is a common cause of infection in both hospitals and the community, and it is becoming increasingly virulent and resistant to antibiotics. The recent sequencing of seven strains of S. aureus provides unprecedented information about its genome diversity. Subtle differences in core (stable) regions of the genome have been exploited by multi-locus sequence typing (MLST) to understand S. aureus population structure. Dramatic differences in the carriage and spread of accessory genes, including those involved in virulence and resistance, contribute to the emergence of new strains with healthcare implications. Understanding the differences between S. aureus genomes and the controls that govern these changes is helping to improve our knowledge of S. aureus pathogenicity and to predict the evolution of super-superbugs.     

What determines nasal carriage of Staphylococcus aureus?

Nasal carriage of Staphylococcus aureus is an important risk factor for infection by this organism in both community and hospital settings; this article reviews the role of host and bacterial factors in carriage. A host genetic influence appears likely but the phenotypic determinants are unknown. Possibilities include variability in host adhesins, immune response or secretion of antimicrobial molecules. Colonization resistance by S. aureus, together with the observation that persistent carriers often carry a single strain whereas intermittent carriers can be colonized with unrelated strains over time, suggests that bacterial factors could also be involved.     

Structural evidence of α-aminoacylated lipoproteins of Staphylococcus aureus

Bacterial lipoproteins are known to be diacylated or triacylated and activate mammalian immune cells via Toll-like receptor 2/6 or 2/1 heterodimer. Because the genomes of low G+C content gram-positive bacteria, such as Staphylococcus aureus, do not contain Escherichia coli-type apolipoprotein N-acyltransferase, an enzyme converting diacylated lipoproteins into triacylated forms, it has been widely believed that native lipoproteins of S. aureus are diacylated. However, we recently demonstrated that one lipoprotein SitC purified from S. aureus RN4220 strain was triacylated. Almost simultaneously, another group reported that another lipoprotein SA2202 purified from S. aureus SA113 strain was diacylated. The determination of exact lipidated structures of S. aureus lipoproteins is thus crucial for elucidating the molecular basis of host-microorganism interactions. Toward this purpose, we intensively used MS-based analyses. Here, we demonstrate that SitC lipoprotein of S. aureus RN4220 strain has two lipoprotein lipase-labile O-esterified fatty acids and one lipoprotein lipase-resistant fatty acid. Further MS/MS analysis of the lipoprotein lipase digest revealed that the lipoprotein lipase-resistant fatty acid was acylated to α-amino group of the N-terminal cysteine residue of SitC. Triacylated forms of SitC with various length fatty acids were also confirmed in cell lysate of the RN4220 and Triton X-114 phase in three other S. aureus strains, including SA113 strain and one Staphylococcus epidermidis strain. Moreover, four other major lipoproteins including SA2202 in S. aureus strains were identified as N-acylated. These results strongly suggest that lipoproteins of S. aureus are mainly in the N-acylated triacyl form.