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1

Eczema herpeticum.  

PubMed

Atopic dermatitis (AD) patients tend to develop viral infections such as herpes simplex, molluscum contagiosum or verrucae vulgares more frequently than nonatopic patients. In addition, disseminated viral infections occur in the skin lesions of AD. Though these diseases are relatively rare and little is known about their specific pathogenesis, some of them are among the true medical emergencies in dermatology. This contribution covers eczema herpeticum, the disseminated viral infection of an eczematous skin disease with the herpes simplex virus, as it is the clinically most important viral complication of AD. PMID:22433376

Wollenberg, Andreas

2012-01-01

2

A case of eczema herpeticum with hailey-hailey disease.  

PubMed

Eczema herpeticum is the dissemination of herpes simplex virus in the setting of a preexisting skin disease. Hailey-Hailey disease [familial benign chronic pemphigus] is a blistering dermatosis that is inherited as an autosomal dominant trait and it usually presents itself around the third or fourth decades. Coexistence of eczema herpeticum and Hailey-Hailey disease is an infrequent occurrence. Four such cases have been reported in the English and German medical literature. We report here on an unusual case of eczema herpeticum that coexisted with Hailey-Hailey disease in a 47 years old man and we review the relevant literatures. PMID:20523813

Lee, Gun Hong; Kim, Yun Mi; Lee, Sung Yul; Lee, Jong Suk; Park, Young Lip; Whang, Kyu Uang

2009-08-01

3

A Case of Eczema Herpeticum with Hailey-Hailey Disease  

PubMed Central

Eczema herpeticum is the dissemination of herpes simplex virus in the setting of a preexisting skin disease. Hailey-Hailey disease [familial benign chronic pemphigus] is a blistering dermatosis that is inherited as an autosomal dominant trait and it usually presents itself around the third or fourth decades. Coexistence of eczema herpeticum and Hailey-Hailey disease is an infrequent occurrence. Four such cases have been reported in the English and German medical literature. We report here on an unusual case of eczema herpeticum that coexisted with Hailey-Hailey disease in a 47 years old man and we review the relevant literatures.

Lee, Gun Hong; Kim, Yun Mi; Lee, Jong Suk; Park, Young Lip; Whang, Kyu Uang

2009-01-01

4

Treatment with acyclovir of genital herpes simplex virus infection complicated by eczema herpeticum.  

PubMed Central

Eczema herpeticum is a potentially serious disease that may be fatal. We report two cases of infection with genital herpes simplex virus (HSV) that were complicated by eczema herpeticum and were treated successfully with acyclovir.

Robinson, G E; Underhill, G S; Forster, G E; Kennedy, C; McLean, K

1984-01-01

5

Eczema herpeticum during Treatment of Atopic Dermatitis with 0.1% Tacrolimus Ointment  

Microsoft Academic Search

Recent evidence suggests that 0.1% tacrolimus ointment is an effective treatment of atopic dermatitis. Tacrolimus is an immunosuppressive agent that interferes with cell-mediated immunity. We have observed 2 cases of eczema herpeticum among 36 patients with atopic dermatitis treated with a topical preparation containing 0.1% tacrolimus. A 29-year-old male patient developed generalized herpetic lesions on his face on the 4th

J. Lübbe; C. C. Pournaras; J.-H. Saurat

2000-01-01

6

Phenotype of Atopic Dermatitis Subjects with a History of Eczema Herpeticum  

PubMed Central

Background A subset of atopic dermatitis (AD) subjectsare susceptible to serious infections with herpes simplex virus, called eczema herpeticum or vaccina virus, called eczema vaccinatum. Objective This National Institute of Allergy and Infectious Disease-funded, multicenter study was performed to establish a database of clinical information and biological samples on subjects with AD with and without a history of eczema herpeticum (ADEH+ and ADEH-, respectively) and healthy controls (CTL). Carefully phenotyping of AD subsets may suggest mechanisms responsible for disseminated viral infections and help identify at-risk individuals. Methods We analyzed the data from 901 subjects (ADEH+ n=134, ADEH- n=419, CTL n=348) enrolled between 5.11.2006 and 9.16.2008 at seven US medical centers. Results ADEH+ subjects had more severe disease based on scoring systems (Eczema Area and Severity Index and Rajka-Langeland), body surface area affected and biomarkers (circulating eosinophil counts, serum IgE, TARC and CTACK) than ADEH- subjects (p<0.001). ADEH+ subjects were also more likely to have a history of food allergy (69 vs 40%; p<0.001) or asthma (64 vs 44%; p<0.001) and were more commonly sensitized to many common allergens (p<0.001). Cutaneous infections with S. aureus or molluscum contagiosum virus were more common in ADEH+ (78% and 8%, respectively) than in ADEH-subjects (29% and 2%; p<0.001). Conclusion AD subjects who develop ADEH have more severe, Th2-polarized disease with greater allergen sensitization and more commonly have food allergy and/or asthma. They are also much more likely to experience cutaneous infections with S. aureus or molluscum contagiosum.

Beck, Lisa A.; Boguniewicz, Mark; Hata, Tissa; Schneider, Lynda C.; Hanifin, Jon; Gallo, Rich; Paller, Amy S.; Lieff, Susi; Reese, Jamie; Zaccaro, Daniel; Milgrom, Henry; Barnes, Kathleen C.; Leung, Donald Y.M.

2011-01-01

7

Genetic Variants in Interferon Regulatory Factor 2 (IRF2) Are Associated with Atopic Dermatitis and Eczema Herpeticum  

Microsoft Academic Search

Interferon regulatory factor 2 (IRF2) is a member of a family of transcriptional factors involved in the modulation of IFN-induced immune responses to viral infection. To test whether genetic variants in IRF2 predict risk of atopic dermatitis (AD) and ADEH (atopic dermatitis complicated by eczema herpeticum), we genotyped 78 IRF2 tagging single-nucleotide polymorphisms (SNPs) in both European-American (n=435) and African-American

Pei-Song Gao; Donald Y M Leung; Nicholas M Rafaels; Mark Boguniewicz; Tracey Hand; Li Gao; Tissa R Hata; Lynda C Schneider; Jon M Hanifin; Terri H Beaty; Lisa A Beck; Adriana Weinberg; Kathleen C Barnes

2012-01-01

8

Psoriasis Herpeticum due to Varicella Zoster Virus: A Kaposi's Varicelliform Eruption in Erythrodermic Psoriasis  

PubMed Central

Kaposi's varicelliform eruption (KVE) or eczema herpeticum is characterized by disseminated papulovesicular eruption caused by a number of viruses like Herpes simplex virus I and II, Coxsackie virus, and Vaccinia and Small pox viruses in patients with pre-existing skin disease. The occurrence of KVE with psoriasis has been reported recently as a new entity psoriasis herpeticum. The rare causation of psoriasis herpeticum due to Varicella zoster virus in a patient with underlying psoriasis is being reported for the first time.

Garg, Geeta; Thami, Gurvinder P

2012-01-01

9

Recurrent MRSA skin infections in atopic dermatitis.  

PubMed

Methicillin-resistant Staphylococcus aureus (MRSA) is a frequent cause of recurrent skin and soft tissue infections. For patients with atopic dermatitis, recurrent skin infections with MRSA often lead to eczema exacerbation. There currently is no standard practice in the prevention of recurrent MRSA soft tissue infections in the general and the atopic dermatitis populations. The current article reviews recent data on S aureus decolonization treatments for the prevention of recurrent MRSA soft tissue infections in the community setting. PMID:25017526

Ong, Peck Y

2014-01-01

10

Eczema: Cause  

MedlinePLUS

... Field Search Button Advanced Search NIAID Home Health & Research Topics Labs & Scientific Resources Funding About NIAID News & Events NIAID > Health & Research Topics > Eczema > Understanding Eczema Understanding What is Atopic Dermatitis? ...

11

Eczema: Complications  

MedlinePLUS

... Field Search Button Advanced Search NIAID Home Health & Research Topics Labs & Scientific Resources Funding About NIAID News & Events NIAID > Health & Research Topics > Eczema > Understanding Eczema Understanding What is Atopic Dermatitis? ...

12

Hand Eczema  

PubMed Central

Hand eczema is often a chronic, multifactorial disease. It is usually related to occupational or routine household activities. Exact etiology of the disease is difficult to determine. It may become severe enough and disabling to many of patients in course of time. An estimated 2-10% of population is likely to develop hand eczema at some point of time during life. It appears to be the most common occupational skin disease, comprising 9-35% of all occupational diseases and up to 80% or more of all occupational contact dermatitis. So, it becomes important to find the exact etiology and classification of the disease and to use the appropriate preventive and treatment measures. Despite its importance in the dermatological practice, very few Indian studies have been done till date to investigate the epidemiological trends, etiology, and treatment options for hand eczema. In this review, we tried to find the etiology, epidemiology, and available treatment modalities for chronic hand eczema patients.

Agarwal, Uma Shankar; Besarwal, Raj Kumar; Gupta, Rahul; Agarwal, Puneet; Napalia, Sheetal

2014-01-01

13

Hand eczema.  

PubMed

Hand eczema is often a chronic, multifactorial disease. It is usually related to occupational or routine household activities. Exact etiology of the disease is difficult to determine. It may become severe enough and disabling to many of patients in course of time. An estimated 2-10% of population is likely to develop hand eczema at some point of time during life. It appears to be the most common occupational skin disease, comprising 9-35% of all occupational diseases and up to 80% or more of all occupational contact dermatitis. So, it becomes important to find the exact etiology and classification of the disease and to use the appropriate preventive and treatment measures. Despite its importance in the dermatological practice, very few Indian studies have been done till date to investigate the epidemiological trends, etiology, and treatment options for hand eczema. In this review, we tried to find the etiology, epidemiology, and available treatment modalities for chronic hand eczema patients. PMID:24891648

Agarwal, Uma Shankar; Besarwal, Raj Kumar; Gupta, Rahul; Agarwal, Puneet; Napalia, Sheetal

2014-05-01

14

Localized psoriasis herpeticum: Case report and review of literature  

PubMed Central

Kaposi's varicelliform eruption (KVE) is a widespread cutaneous eruption caused by viruses, especially herpes simplex virus in patients with pre-existing dermatoses. “Psoriasis herpeticum” refers to the rare occurrence of KVE in patients with psoriasis. We report a case of KVE localized to the face in a patient with exfoliative dermatitis secondary to psoriasis. This case is being reported to make the treating clinician aware of the possibility of KVE in patients with psoriatic erythroderma.

George, Mamatha; Pakran, Jaheersha; Rajan, Uma; George, Sandhya; Thomas, Sumi

2011-01-01

15

[Allergic contact eczema].  

PubMed

Allergic contact eczema due to type IV reactions are more frequent than irritative eczema in facial skin, particularly in the sensitive periorbital region. Concomitant eczema of different locations is pathognomonic and allows a distinction from seborrhoic dermatitis. Avoidance of allergen exposure is mandatory for an effective treatment; therefore allergological examinations have a very high significance. Patch tests with a wide spectrum of potential allergens have to be included in these tests. Therapeutic regimes include a restrictive use of topical steroids. Substances like calcineurin inhibitors are the first-line therapy in facial atopic dermatitis, in spite of therapeutic effects, they have not yet been approved for other forms of periorbital dermatitis. PMID:24799172

Brehler, R; Grundmann, S

2014-05-01

16

Eczema (For Parents)  

MedlinePLUS

... corticosteroids , also called cortisone or steroid creams or ointments, are commonly used to treat eczema and are ... steroid prescribed for someone else. These creams and ointments vary in strength, and using the wrong strength ...

17

Treating Eczema with Steroids  

MedlinePLUS

... common forms of eczema is atopic dermatitis, or AD, which can occur on just about any body part. AD takes a physical and emotional toll because it ... a “mild” form of the disease, meaning the AD affects less than 20 percent of the body ...

18

"Eczema Coxsackium" and Unusual Cutaneous Findings in an Enterovirus Outbreak  

PubMed Central

OBJECTIVE: To characterize the atypical cutaneous presentations in the coxsackievirus A6 (CVA6)–associated North American enterovirus outbreak of 2011–2012. METHODS: We performed a retrospective case series of pediatric patients who presented with atypical cases of hand, foot, and mouth disease (HFMD) from July 2011 to June 2012 at 7 academic pediatric dermatology centers. Patients were included if they tested positive for CVA6 or if they met clinical criteria for atypical HFMD (an enanthem or exanthem characteristic of HFMD with unusual morphology or extent of cutaneous findings). We collected demographic, epidemiologic, and clinical data including history of skin conditions, morphology and extent of exanthem, systemic symptoms, and diagnostic test results. RESULTS: Eighty patients were included in this study (median age 1.5 years, range 4 months–16 years). Seventeen patients were CVA6-positive, and 63 met clinical inclusion criteria. Ninety-nine percent of patients exhibited a vesiculobullous and erosive eruption; 61% of patients had rash involving >10% body surface area. The exanthem had a perioral, extremity, and truncal distribution in addition to involving classic HFMD areas such as palms, soles, and buttocks. In 55% of patients, the eruption was accentuated in areas of eczematous dermatitis, termed “eczema coxsackium.” Other morphologies included Gianotti-Crosti–like (37%), petechial/purpuric (17%) eruptions, and delayed onychomadesis and palm and sole desquamation. There were no patients with serious systemic complications. CONCLUSIONS: The CVA6-associated enterovirus outbreak was responsible for an exanthem potentially more widespread, severe, and varied than classic HFMD that could be confused with bullous impetigo, eczema herpeticum, vasculitis, and primary immunobullous disease.

Oza, Vikash; Frieden, Ilona J.; Cordoro, Kelly M.; Yagi, Shigeo; Howard, Renee; Kristal, Leonard; Ginocchio, Christine C.; Schaffer, Julie; Maguiness, Sheilagh; Bayliss, Susan; Lara-Corrales, Irene; Garcia-Romero, Maria Teresa; Kelly, Dan; Salas, Maria; Oberste, M. Steven; Nix, W. Allan; Glaser, Carol; Antaya, Richard

2013-01-01

19

Recreational Water Illness (RWI): MRSA  

MedlinePLUS

... MRSA website. Can MRSA be spread at recreational water facilities? MRSA does not survive long in recreational ... myself, my family, and others when visiting recreational water facilities? Take action! There are steps you can ...

20

Pet Care: MRSA FAQ  

MedlinePLUS

... should be treated by a healthcare provider. When animals are colonized with MRSA (usually by testing swabs taken of the nostrils), there are no recognized methods for decolonizing them. Based on clinical cases observed, ... companion animals are generally transient carriers of MRSA, meaning they ...

21

MRSA in Schools  

ERIC Educational Resources Information Center

Methicillin-resistant Staphylococcus aureus (MRSA) is a form of Staphylococcus aureus, a common bacterium that has developed resistance to several forms of antibiotics. MRSA has been around for many years, mostly in health care settings but has moved into the community in recent years. Infections can be seen anywhere but are mostly seen in…

US Department of Education, 2007

2007-01-01

22

What is MRSA?  

PubMed

For decades methicillin-resistant Staphylococcus aureus (MRSA) has been considered the prototype of multi-resistant nosocomial pathogens, causing infections in high-risk patients. Changes in the healthcare system, coupled with the evolution of this versatile microorganism, have transformed MRSA into a cause of community-onset infections, in both patients who have contact with the healthcare system and patients without such a risk factor. New lineages of MRSA, defined as community acquired (CA)-MRSA, have emerged that have a propensity to cause infections in young individuals without risk factors. CA-MRSA primarily causes skin infections and, rarely, necrotising pneumonia. In the USA, these strains belong to a single widespread clone, designated USA300, while in Europe they belong to a variety of clones. Most strains carry genes for the Panton-Valentine leukocidin, whose role in diseases is under debate. In subjects living in the community who have contact with the healthcare system, MRSA strains of the nosocomial type are a frequent cause of infection and of pneumonia in particular. The detection of a large MRSA reservoir in pigs and the finding that professionally exposed individuals are colonised, has further shown that it is necessary to closely follow the epidemiology of MRSA if we want to combat it effectively. PMID:19880619

Pantosti, A; Venditti, M

2009-11-01

23

Superimposed MRSA infection of vulvar eczematous dermatitis  

PubMed Central

Background Vulvar eczematous dermatitis predisposes patients to superimposed infections, which may result in late diagnosis and architectural destruction. Methicillin resistant staphylococcus aureus (MRSA) infection is on the rise in genitalia and lower extremities. Case 44 year-old female presented with recurrent vulvar lesions and pain. A diagnosis of methicillin resistant staphylococcus aureus in the setting of eczema was achieved with concomitant use of photography and dermatopathologic review. Antibiotics were tailored to the resistant infection and preventative moisturization therapy was utilized. Conclusion Awareness of dermatologic conditions affecting the vulva is principal in routine gynecologic care. Barrier protection of eczematous vulvar skin may prevent superficial infections. The regular use of photographic documentation and dermatopathology may decrease time to diagnosis with infrequent conditions.

Carey, Erin; Zedek, Daniel; Lewis, Jasmine; Zolnoun, Denniz

2014-01-01

24

Bacterial infection and atopic eczema  

Microsoft Academic Search

One hundred and ninety children with atopic eczema were studied prospectively for two and a half years. The mean period of observation was 13 months. Seventy six children (40%) had between them 164 episodes of exacerbation of eczema due to bacterial infection, and in 52 (32%) infection recurred within three months of a previous infection. Twenty five episodes (15%) led

T J David; G C Cambridge

1986-01-01

25

MRSA and the Workplace  

MedlinePLUS

... with someone else's infection (e.g., towels, used bandages). MRSA skin infections can occur anywhere. However, some ... be covered and contained with a clean, dry bandage and for those who cannot maintain good hygiene ...

26

Seasonality of MRSA Infections  

PubMed Central

Using MRSA isolates submitted to our hospital microbiology laboratory January 2001–March 2010 and the number of our emergency department (ED) visits, quarterly community-associated (CA) and hospital-associated (HA) MRSA infections were modeled using Poisson regressions. For pediatric patients, approximately 1.85x (95% CI 1.45x–2.36x, adj. p<0.0001) as many CA-MRSA infections per ED visit occurred in the second two quarters as occurred in the first two quarters. For adult patients, 1.14x (95% CI 1.01x–1.29x, adj.p?=?0.03) as many infections per ED visit occurred in the second two quarters as in the first two quarters. Approximately 2.94x (95% CI 1.39x–6.21x, adj.p?=?0.015) as many HA-MRSA infections per hospital admission occurred in the second two quarters as occurred in the first two quarters for pediatric patients. No seasonal variation was observed among adult HA-MRSA infections per hospital admission. We demonstrated seasonality of MRSA infections and provide a summary table of similar observations in other studies.

Mermel, Leonard A.; Machan, Jason T.; Parenteau, Stephen

2011-01-01

27

Patient perceptions of MRSA.  

PubMed

Drug-resistant nosocomial infections are an increasing problem. This issue has received considerable media coverage. To our knowledge there have been no studies investigating patient awareness and perceptions of nosocomial infections. A total of 113 surgical out-patients completed a questionnaire stating whether they had heard of either superbugs or MRSA. A series of questions were asked about the source of any information; methods of transmission and prevention; the consequences of infection and their emotional response if they were to acquire MRSA. Fifty patients (44%) had heard of superbugs or MRSA mainly via the media (58%) or from hospital staff (44%). The majority would feel either angry or afraid if they acquired MRSA in hospital, but there was good awareness of both methods of infection control and the consequences of infection. From our study, we conclude that the media is at least as important as health professionals in providing information. Concerns regarding nosocomial infection may need to be addressed prior to admission. PMID:12648346

Hamour, Sally M A; O'Bichere, Austin; Peters, John L; McDonald, Peter J

2003-03-01

28

A case discussion on eczema.  

PubMed

Eczema is a form of dermatitis where inflammation of epidermis occurs. The exact cause of eczema is not known. Although it is activated by the immune system and is related to allergic reactions, it is not the same as other allergic reactions. In Ayurveda, the disease is described by the name "Vicharchika." Virechana is the best line of management for skin disorders. Controlling eczema more effectively can make a radical improvement to the patient's quality of life. A case report of 45-year-old male, who presented with complaints of rashes over dorsum of both foot associated with intense itching and burning sensation, oozing wound posterior to lateral malleolus and dorsum of left foot has been presented here. PMID:21455456

Hegde, Pallavi; Hemanth, D T; Emmi, S V; Shilpa, M P; Shindhe, Pradeep S; Santosh, Y M

2010-10-01

29

A case discussion on eczema  

PubMed Central

Eczema is a form of dermatitis where inflammation of epidermis occurs. The exact cause of eczema is not known. Although it is activated by the immune system and is related to allergic reactions, it is not the same as other allergic reactions. In Ayurveda, the disease is described by the name “Vicharchika.” Virechana is the best line of management for skin disorders. Controlling eczema more effectively can make a radical improvement to the patient's quality of life. A case report of 45-year-old male, who presented with complaints of rashes over dorsum of both foot associated with intense itching and burning sensation, oozing wound posterior to lateral malleolus and dorsum of left foot has been presented here.

Hegde, Pallavi; Hemanth, D T; Emmi, S V; Shilpa, M P; Shindhe, Pradeep S; Santosh, Y M

2010-01-01

30

Chinese herbal medicine research in eczema treatment  

PubMed Central

Eczema is a chronic relapsing atopic dermatitis (AD) associated with pruritus, sleep disturbance and poor quality of life of the patient. Treatment of eczema includes use of emollient, topical and systemic antimicrobial agents, corticosteroid or immunomodulating agents. Many patients also seek alternative treatments such as dietary avoidance, supplementation or both. This article reviews the basic pathophysiology of eczema and clinical trials involving Chinese medicine in the treatment of eczema. Research reports on Chinese herbal medicine for eczema were retrieved from PubMed and the Cochrane Database for Systematic Reviews for this review. Only a few RCTs demonstrated the efficacy (or lack of efficacy) of Chinese medicinal herbs in treating atopic eczema. Further larger scale trials are warranted.

2011-01-01

31

Therapeutic management of atopic eczema.  

PubMed

The present review aims at giving a condensed view on the current status of therapy of atopic eczema - a common chronically relapsing inflammatory skin disease. Atopic eczema is a multifactorial disease with a tendency for chronification. Owing to the associated genetic factors, therapeutic amelioration of skin symptoms is often only transient. Therefore, treatment basically focuses on symptomatic relief. Atopic treatment should more than any other disease be guided by an individualized approach taking not only the phenotype and genotype of the disease but also psychosocial and gender aspects into account. Significant gains have been made in our understanding of atopic eczema, especially recent insights into genetic and immunologic mechanisms, but still, there is no single treatment to date that has proven to be the quantum leap for atopic patients. Novel treatments have been developed and trialled, however, more studies on novel therapies such as biologicals addressing efficacy, optimum dose and duration of treatment and the target phenotype are urgently needed. Hopefully, the tremendous progress in basic research in the last years will provide new targets for prevention and treatment in the future. PMID:20406188

Traidl-Hoffmann, Claudia; Mempel, Martin; Beloni, Benedetta; Ring, Johannes; Schnopp, Christina

2010-03-01

32

Atopic dermatitis/atopic eczema.  

PubMed

Atopic dermatitis was described in 1933 but exists since antiquity. We review descriptions of a childhood skin disease compatible with our modern diagnosis of atopic dermatitis, in ancient medicine and in nineteenth century dermatology texts. We identify Hebra's prurigo and Besnier's diathetic prurigo as forerunners of atopic dermatitis, the latter being a synthesis of infantile eczema and prurigo. The pathogenic theories which link atopic dermatitis to humoralistic medicine, to digestive diseases, to allergy may have had consequences on today's reluctance to consider atopic dermatitis as a skin disorder, the treatment of which relies mainly on topicals. © 2014 S. Karger AG, Basel. PMID:24925387

Wallach, Daniel; Taïeb, Alain

2014-01-01

33

Childhood eczema treatment: the barriers.  

PubMed

Childhood eczema has a significant impact on the quality of life of children and their families, yet the main cause of treatment failure is parents/carers not using prescribed topical treatments. This article reports the results of a study that explored carers' experiences of barriers to treatment adherence and how they sought to overcome these. We found that regular application of topical treatments can be highly challenging, particularly in families where child resistance develops. Our findings are considered alongside research into other long-term childhood conditions. PMID:24881180

Santer, Miriam

34

Eczema, Sleep, and Behavior in Children  

PubMed Central

Introduction: There is a general consensus that sleep disruption in children causes daytime behavioral deficits. It is unclear if sleep disruption in children with eczema has similar effects particularly after controlling for known comorbid disorders such as asthma and rhinitis. Methods: Parents of children (6-16 y) with eczema (n = 77) and healthy controls (n = 30) completed a validated omnibus questionnaire which included the Sleep Disturbance Scale for Children, Conners Parent Rating Scale-Revised (S), Child Health Questionnaire, Children's Dermatology Life Quality Index, and additional items assessing eczema, asthma, rhinitis, and demographics. Results: Compared to controls, children with eczema had a greater number of sleep problems with a greater percentage in the clinical range, lower quality of life, and higher levels of ADHD and oppositional behavior. They also had elevated rhinitis and asthma severity scores. Importantly, structural equation modelling revealed that the effect of eczema on the behavioral variables of Hyperactivity, ADHD Index, and Oppositional Behaviors were mediated through sleep with no direct effect of eczema on these behaviors. The comorbid atopic disorders of rhinitis and asthma also had independent effects on behavior mediated through their effects on sleep. Conclusions: The present findings suggest that the daytime behaviors seen in children with eczema are mediated independently by the effects of eczema, asthma, and rhinitis on sleep quality. These findings highlight the importance of sleep in eczematous children and its role in regulating daytime behavior. Citation: Camfferman D; Kennedy JD; Gold M; Martin AJ; Winwood P; Lushington K. Eczema, sleep, and behavior in children. J Clin Sleep Med 2010;6(6):581-588.

Camfferman, Danny; Kennedy, J. Declan; Gold, Michael; Martin, A. James; Winwood, Peter; Lushington, Kurt

2010-01-01

35

Eczema  

MedlinePLUS

... treatment plan. Use fragrance-free moisturizers. Cream or ointment is more moisturizing than lotion. After a bath, ... to the skin (topical) —Available as creams or ointments. Taken by mouth (oral) —Available in pill or ...

36

Eczema  

MedlinePLUS

... substitute, use a facial moisturizer that says noncomedogenic/oil-free, and apply only hypoallergenic makeup and sunscreens. ... not captured in the skin. Say yes to cotton. Clothes made of scratchy fabric like wool can ...

37

[Management of chronic hand eczema].  

PubMed

The management of hand eczema, more readily called chronic hand dermatitis, is complex. This heaviness is related not only to the disease itself by its different clinical forms but also the multiplicity and diversity of etiological factors, triggering / maintaining or aggravating factors. The repeated therapeutic failures are ransom of incorrect information about the disease and its environment, a lack of clarity in the prescription and duration of treatment in general too short. The reference treatment is high potency topical steroids with or without occlusion for 4-8 weeks followed by alitretinoin 30mg / day for at least 3-6 months with a monthly lipid and liver monitoring and mandatory monthly pregnancy test in women of childbearing. Associated measures and patient education are the cornerstones of successful treatment. Other alternative treatments such as phototherapy, methotrexate, cyclosporin, mycophenolate mofetil etc. can be considered in case of resistance or for clearing followed by topical treatments. PMID:24953623

Lahfa, M

2014-06-01

38

MRSA - Multiple Languages: MedlinePlus  

MedlinePLUS

... Hindi (??????) Japanese (???) Korean (???) Portuguese (português) Russian (???????) Somali (af Soomaali) Spanish (español) Tagalog ( ... PDF Health Information Translations Return to top Portuguese (português) MRSA (Methicillin Resistant Staphylococcus Aureus) MRSA (Staphylococcus aureus ...

39

Community-associated MRSA (CA-MRSA): an emerging pathogen in infective endocarditis  

Microsoft Academic Search

Over the last decade, a novel methicillin-resistant Staphylococcus aureus (MRSA) has emerged, primarily associated with healthy individuals within the community. This organism is distinct from healthcare-associated MRSA (HA-MRSA) in terms of epidemiology, microbiology and clinical manifes- tation and as such has been defined as community-associated MRSA (CA-MRSA). Given that S. aureus is a major aetiological agent of infective endocarditis (IE),

B. Cherie Millar; Bernard D. Prendergast; John E. Moore

2007-01-01

40

New Eczema Drug Shows Promise in Early Trials  

MedlinePLUS

... sharing features on this page, please enable JavaScript. New Eczema Drug Shows Promise in Early Trials Dupilumab ... Eczema THURSDAY, July 10, 2014 (HealthDay News) -- A new drug that scientists hope will relieve the debilitating ...

41

Livestock-associated MRSA in veal farming : risk factors for MRSA carriage in veal calves and humans  

Microsoft Academic Search

Traditionally,Methicillin-resistant Staphylococcus aureus (MRSA) has been considered as a hospital-associated pathogen (HA-MRSA). However, since 2004, MRSA has been found to be emerging in livestock (LA-MRSA), particularly pigs and veal calves. Animals have the capacity to act as reservoirs of MRSA, and potentially transmit this bacterium to humans in close contact with MRSA-colonized animals. This thesis focuses on MRSA in veal

H. Graveland

2011-01-01

42

Preventing MRSA infection in the community.  

PubMed

About two years ago, the death of a high school student athlete brought methicillin-resistant Staphylococcus aureus (MRSA) into the national spotlight. Preventing the spread of MRSA in schools, gyms, and other public facilities is an important public health goal. This Issue Brief presents current information on the prevalence and transmission of MRSA in community settings, and describes ongoing research on interventions to limit the spread of this increasingly common infection. PMID:19780236

Lautenbach, Ebbing; Zaoutis, Theoklis

2009-08-01

43

MRSA and cataract surgery - reflections for practice  

PubMed Central

Introduction Postoperative bacterial endophthalmitis is a devastating complication of cataract surgery. Methicillin-resistant Staphylococcus aureus (MRSA) endophthalmitis is rare. Recent debate over MRSA screening in United Kingdom (UK) National Health Service (NHS) hospital services has implications for cataract patients and ophthalmology services. Aims To discuss issues for clinical practice as based on reflective experience at a UK district general NHS hospital in relation to care of MRSA-positive cataract patients. Methods Retrospective case series and reflective practice. Results Three cases presented highlight practice points around cataract patients colonized with MRSA. Known or determined MRSA-colonized patients should be treated with anti-microbial agents at time of cataract surgery known to be active against MRSA. Preventative treatment with intracameral vancomycin or intravenous teicoplanin alongside appropriate topical treatments may be of merit. Importantly fluoroquinolones, often prescribed by cataract surgeons, may have a selective effect favoring the proliferation of MRSA. Conclusion MRSA screening may cause unnecessary delays in cataract care and may represent a patient safety concern in its own right. Patients colonized with MRSA may safely undergo cataract surgery provided there is no evidence of periorbital infection and provided appropriate infection control and antibiotic prophylaxis measures are used. The well-prepared cataract surgeon needs to be aware of developments in infection control and should liaise with local clinical microbiology colleagues in relation to bacterial resistance to antibiotics.

Porter, LF; Khan, RU; Hannan, A; Kelly, SP

2010-01-01

44

Novel Unconventional Therapeutic Approaches to Atopic Eczema  

Microsoft Academic Search

Atopic eczema is a chronic, recurrent, multifactorial skin disease, and, accordingly, there are numerous therapeutic options for its symptomatic treatment. Conventional medications are however often unsatisfactory for many patients because of adverse effects on long-term use. For this reason, patients often readily welcome unconventional therapeutic approaches. We present here a selected number of such treatment modalities, namely ?-linolenic acid, Chinese

Margitta Worm; Beate M. Henz

2000-01-01

45

Breast feeding, eczema, asthma, and hayfever  

Microsoft Academic Search

The association of breast feeding with rates of atopic illness during the first five years of life was assessed in a national study of 13 135 children studied during the first week and at age 5 years. Eczema was reported more often in children who had been breast fed; this relationship persisted even after allowance was made for social and

B Taylor; J Wadsworth; J Golding; N Butler

1983-01-01

46

MRSA transmission between cows and humans  

Microsoft Academic Search

We isolated methicillin-resistant Staphylococcus aureus (MRSA) from cows with subclinical mastitis and from a person who worked with these animals. The bovine and human strains were indistinguishable by phenotyping and genotyping methods and were of a low frequency spa type. To our knowledge, this finding indicates the first documented case of direct transmission of MRSA between cows and humans.

Eva Juhasz-Kaszanyitzky; S. Janosi; P. Somogyi; A. Dan; Graaf-van Bloois van der L; Dulijkeren van E; J. A. Wagenaar

2007-01-01

47

Psychosocial adjustment in preschool children with atopic eczema  

Microsoft Academic Search

Atopic eczema is a chronic skin disorder that is most common in early childhood, an important stage in the child's social and emotional development. The psychiatric adjustment and mother-child attachment in 30 preschool children with severe atopic eczema was compared with 20 matched controls. Patients with eczema had a significant increase in behaviour symptoms, 7\\/30 (23%) v 1\\/20 (5%); with

L R Daud; M E Garralda; T J David

1993-01-01

48

Mite elimination--clinical effect on eczema.  

PubMed

Allergic reactivity to house-dust mites (HDM) can be detected in patients with atopic eczema by prick and patch test challenge. To determine the clinical relevance of this reactivity, we performed a placebo-controlled, double-blind trial of anti-HDM measures. Active treatment comprised Gortex bags for all the bedding elements, a high-powered vacuum cleaner, and a spray containing benzyl alcohol and tannic acid to kill mites and denature allergens. Placebo treatment was light cotton bags, a cheap vacuum cleaner, and water spray. Forty-eight patients (28 active group) completed the trial, which lasted 6 months. Dust was sampled from the mattress surface and bedroom and living-room carpets before and at monthly intervals after institution of the measures. Dust was weighed and Der p 1 determined by ELISA (ALK). Patients were assessed for area and severity of eczema by a blinded observer. There was a highly significant reduction in bed surface dust - most beds yielded insufficient dust to extract and assay. Carpet Der p 1 levels were reduced to similar minimal levels by both active and placebo treatments (about 250 ng/m2). There were highly significant benefits on the eczema scores, the active treatment being greatly superior to placebo (P< or =0.0006; analysis of covariance). In conclusion, Gortex bed bags were highly effective at containing dust within the bed. This was associated with clinical improvement in most patients with atopic eczema - the biggest improvements were seen in the most severely affected subjects. PMID:10096818

Friedmann, P S; Tan, B B

1998-01-01

49

[From atopic eczema to respiratory allergy].  

PubMed

The prevalence of atopic eczema in childhood is increasing. This is probably related with a deviation of immune system to Th2 directed to allergen instead of Th2 directed to microorganisms. Atopic eczema is genetically linked, but its expression is principally determined by environmental factors, allergens and infections. In children with atopic eczema, the immune system is altered. The number of Langheran's cells is augmented. Th2 cells infiltrate the skin and produce cytokines which mediate both immediate and late allergic reaction. Most of eczematous children is allergic to food. A IgE-mediated reaction take place at the mucosal intestinal site. The food challenge test is the most reliable mean to identify offending foods. Soy formula can be used in the treatment of cow milk allergy. The tolerance of formulae based on cow milk hydrolysed protein should be tested under medical supervision in children with cow milk allergy. Prevention of atopic disease with dietary interventions has not been successful. To prevent asthma, the administration of immunotherapy in children with allergic rhinitis seems to be promising. In eczematous children with elevated total IgE and specific IgE to inhalant allergens, cetarizine seems to prevent onset of asthmatic symptoms. PMID:11424613

Caffarelli, C; Cavagni, G

2000-01-01

50

Laboratory Evaluation of the BD MAX MRSA Assay.  

PubMed

A comparison between the BD MAX MRSA and Xpert MRSA assays was performed using 239 nares samples. A 97.9% overall agreement between the two molecular assays was observed. The BD MAX MRSA assay proved to be a reliable alternative for a highly automated system to detect methicillin-resistant Staphylococcus aureus (MRSA) in patient nares samples. PMID:24829235

Widen, Raymond; Healer, Vicki; Silbert, Suzane

2014-07-01

51

Methicillin-Resistant Staphylococcus aureus (MRSA) Treatment  

MedlinePLUS

... antibiotics, your provider will consider the potential for antibiotic resistance. Thus, if MRSA is suspected, your provider will avoid treating you with beta-lactam antibiotics, a class of antibiotic observed not to be ...

52

Eczema Increases Susceptibility to PM10 in Office Indoor Environments  

Microsoft Academic Search

The objective was to compare impact of indoor office environment on employees with eczema with those without eczema. Exposure was measured at 56 sites and modelled for 173 work places. Tear film stability, lysozyme in nasal lavage, immunoglobulin E (IgE), and Phadiatop were assessed, and symptoms and perceptions collected by questionnaires. Multiple regression analyses were applied, adjusted for age, gender,

Jan Vilhelm Bakke; Gunilla Wieslander; Dan Norback; Bente E. Moen

2012-01-01

53

Incidence of hand eczema in female Swedish hairdressers  

PubMed Central

Objective To estimate the occurrence of hand eczema in hairdressers in Sweden. Methods The occurrence of hand eczema was estimated in a Swedish longitudinal retrospective cohort study including all female graduates from vocational schools for hairdressers from 1970 to 1995. A stratified sample from the general population acted as controls. A self?administered questionnaire including questions on the occurrence of hand eczema, skin atopy, working periods and number of hair treatments performed per week was sent to the participants. Incidence rate ratios (IRRs) of hand eczema were estimated. Results The incidence rate of hand eczema in hairdressers was 23.8 cases/1000 person?years, whereas in hairdressers who were aged <25?years it was 37.1/1000 person?years. The corresponding IRR for hairdressers compared with controls was 2.5 (95% confidence interval (CI) 2.2 to 2.8), and that for younger hairdressers was 3.1 (95% CI 2.6 to 3.5). The mean age at onset of hand eczema was 21.6?years for hairdressers and 21.2?years for controls. The 1?year prevalence of hand eczema was 18.0% for hairdressers and 12.1% for controls. A large number of hair treatments involving exposure to skin irritants and sensitisers were reported. The incidence rate of hand eczema was higher among individuals with a history of childhood eczema, both for hairdressers and for controls, giving an (age?adjusted) IRR of 1.9 and 2.2, respectively. The attributable fraction of hand eczema from skin atopy was 9.6%. A synergistic effect of skin atopy and hairdressing was found on the occurrence of hand eczema. The relative excess risk due to interaction was 1.21 (95% CI 0.21 to 2.21; p?=?0.01). Conclusion Hairdressers are highly exposed to skin?damaging substances. The self?reported incidence of hand eczema was substantially higher in female hairdressers than in controls from the general population and than that found previously in register?based studies. For many individuals, onset of hand eczema occurs early in life. Only about 10% of the hand eczema cases among hairdressers would be prevented if no one with skin atopy entered the trade.

Lind, Marie-Louise; Albin, Maria; Brisman, Jonas; Diab, Kerstin Kronholm; Lillienberg, Linnea; Mikoczy, Zoli; Nielsen, Jorn; Rylander, Lars; Toren, Kjell; Meding, Birgitta

2007-01-01

54

Association of Methicillin-Resistant Staphylococcus aureus (MRSA) USA300 Genotype with Mortality in MRSA Bacteremia  

PubMed Central

Objectives To evaluate the association of USA300 genotype with outcomes in persons with MRSA bacteremia and examine the epidemiology of MRSA bacteremia over time. Methods Population-based surveillance for MRSA bacteremia was performed in 8-county Atlanta from 2005–2008. Cases of MRSA bacteremia were classified as healthcare-associated with hospital-onset (HAHO), healthcare-associated with community-onset (HACO), or community-associated (CA) disease. A survival analysis was performed on a nested cohort of cases with isolates characterized by pulse field gel electrophoresis (PFGE). Results 4344 MRSA bacteremia cases were identified; 2579 (59.4%) HACO, 1144 (26.3%) HAHO; and 601 (13.8%) CA. Overall incidence rates of MRSA bacteremia declined from 33.9/100,000 in 2005 to 24.8/100,000 in 2008. Rates were highest in persons ? 65 years, blacks, males, and persons with AIDS. In multivariate analysis of 1104 cases, USA300 genotype was associated with increased in-hospital mortality (HR 1.63, 95% CI 1.19–2.23). USA300 strains were also associated with increased mortality when compared to USA100 strains (HR 1.79, 95% CI 1.24–2.58). Conclusions MRSA bacteremia incidence declined over 4 years but CA disease rates remained stable. Persons with HIV, the elderly, and blacks were disproportionately affected. Bacteremia due to USA300 MRSA strains was associated with increased mortality, suggesting that USA300 strains may be more virulent.

Kempker, Russell R.; Farley, Monica M.; Ladson, Janine L.; Satola, Sarah; Ray, Susan M.

2010-01-01

55

MRSA CC398 in the pig production chain.  

PubMed

In 2005, a distinct clone of methicillin resistant Staphylococcus aureus (MRSA CC398) was found in pigs and people in contact with pigs. The structure of the pig production chain in high technology pig husbandry enables pathogens to spread during animal trading, with an increasing prevalence in herds further down the chain. The objective of this study was to quantify the effect of the MRSA status of the supplying herd on the MRSA status of the receiving herd in order to gain more insight into the role of animal trading as a transmission route for MRSA CC398. Nasal samples (60-80 pigs per herd) were collected from 38 herds; in 20 herds, environmental samples were collected as well. Ten MRSA-positive herds (based on the results of nasal swabs of 10 individual pigs per herd) from a prior study were included in the data analysis. Herds were classified as MRSA positive if at least one sample tested positive. The 48 herds were part of 14 complete (40 herds) and 4 incomplete (8 herds) pig production chains. Fifty-six percent of the herds were classified as MRSA positive. MRSA-positive herds were observed at the start (breeding herds), middle (farrowing herds) and the end (finishing herds) of the pig production chain. All of the herds in 8 chains tested MRSA positive;, all of the herds in 5 chains tested MRSA negative and in the remaining 5 chains, MRSA-positive and MRSA-negative herds were detected. Seven spa types were found, which were all previously confirmed to belong to CC398. All of the isolates were susceptible to mupirocin, linezolid, rifampicin, fusidic acid and cotrimoxazole. Resistance against tetracycline, erythromycin and clindamycin was found in 100, 74 and 76% of the isolates, respectively. Seventy-nine percent of herds with a MRSA-positive supplier of pigs were MRSA positive, whereas 23% of herds with a MRSA-negative supplier were MRSA positive (OR=10.8; 95% CI: 1.5-110.1; P=0.011). The presence of entirely MRSA-positive and MRSA-negative chains and the strong association between the MRSA status of herds and their suppliers illustrates a large risk associated with purchasing pigs from MRSA-positive herds; a top-down strategy for future control programs is, therefore, a basic requirement. However, 23% of herds with a MRSA-negative supplier were MRSA positive and furthermore, 46% of the herds at the top of the pig production chain without a supplier tested MRSA positive. This underlined the need for the identification of additional risk factors for MRSA. PMID:21075466

Broens, E M; Graat, E A M; van der Wolf, P J; van de Giessen, A W; van Duijkeren, E; Wagenaar, J A; van Nes, A; Mevius, D J; de Jong, M C M

2011-02-01

56

Early melanoma with halo eczema (Meyerson's phenomenon).  

PubMed

We present a case of a 49-year-old man who presented with a solitary atypical pigmented lesion with a surrounding halo of dermatitis. Dermoscopy showed a pigment network at the periphery with areas of scar-like depigmentation, negative pigment network and erythema. The lesion was treated preoperatively with a potent topical corticosteroid resulting in a reduction of inflammation. Histology showed an early Clark level 1 melanoma arising within a severely dysplastic compound melanocytic naevus. There was an adjacent perivascular chronic inflammatory cell infiltrate with occasional eosinophils. Minimal, though definite spongiosis with parakeratosis was also present. The scar was subsequently re-excised achieving appropriate excision margins for melanoma in situ. Six months later, there was recurrence of dermatitis at the scar with no evidence of recurrent melanoma. To our knowledge, melanoma with Meyerson phenomenon has not been reported in the literature. This case highlights that all lesions should be evaluated on clinical and dermoscopic grounds regardless of the presence or absence of eczema. Our case adds yet another entity that may display Meyerson phenomenon and consequently a halo of eczema cannot be considered a reassuring sign when evaluating melanocytic lesions. PMID:21332699

Rodins, Karl; Byrom, Lisa; Muir, Jim

2011-02-01

57

[MRSA - hygiene management, diagnostics and treatment].  

PubMed

Methicillin-resistant Staphyococcus aureus strains remain a challenge to both patient care and infection control efforts. In addition to the defining resistance to beta-lactams several other antibiotic classes may be ineffective. Some resistance phenotypes exhibit a characteristic distribution pattern between healthcare-associated, community-associated, and livestock-associated MRSA strains. For patients with defined risk factors a search-, destroy-, follow-up-strategy is recommended in order to identify and eliminate MRSA colonization. Mupirocin nasal ointment and extensive hygiene measures are the mainstays of decolonization efforts. Besides vancomycin several other antimicrobials such as rifampin, trimethoprim-sulfamethoxazol, clindamycin, linezolid, and daptomycin are used to treat specific MRSA infections. PMID:24648177

Wagener, J; Seybold, U

2014-03-01

58

Endotoxin Exposure and Eczema in the First Year of Life  

PubMed Central

Objective Exposure to endotoxin in early life has been proposed as a factor that may protect against the development of allergic diseases such as eczema. The objective of this study was to examine the relation between endotoxin exposure in early life and eczema in the first year of life in children with parental history of asthma or allergies. Methods This study used a prospective birth cohort study of 498 children who had a history of allergy or asthma in at least 1 parent and lived in metropolitan Boston. A subset of 401 living rooms had house dust samples adequate for analysis of endotoxin. Results In multivariate analyses adjusting for gender, income, and season of birth, endotoxin levels in the living room at 2 to 3 months of age was inversely associated with physician- or nurse-diagnosed eczema in the first year of life (odds ratio [OR] for each quartile increment: 0.76; 95% confidence interval [CI]: 0.61–0.96). Exposure to a dog in the home at age 2 to 3 months was also inversely associated with eczema in the first year of life, but the CI widened when endotoxin was included in the multivariate model (OR: 0.54; 95% CI: 0.27–1.09). Other variables associated with eczema in the first year of life included paternal history of eczema (OR: 1.91; 95% CI: 1.03–3.55) and maternal specific immunoglobulin E positivity to ?1 allergen (OR: 1.61; 95% CI: 1.01–2.56). Conclusions Among children with parental history of asthma or allergies, exposure to high levels of endotoxin in early life may be protective against eczema in the first year of life. In these children, paternal history of eczema and maternal sensitization to at least 1 allergen are associated with an increased risk of eczema in the first year of life.

Phipatanakul, Wanda; Celedon, Juan C.; Raby, Benjamin A.; Litonjua, Augusto A.; Milton, Donald K.; Sredl, Diane; Weiss, Scott T.; Gold, Diane R.

2005-01-01

59

MRSA prevalence in european healthcare settings: a review  

Microsoft Academic Search

Background  During the past two decades, methicillin-resistant Staphylococcus aureus (MRSA) has become increasingly common as a source of nosocomial infections. Most studies of MRSA surveillance were performed\\u000a during outbreaks, so that results are not applicable to settings in which MRSA is endemic. This paper gives an overview of\\u000a MRSA prevalence in hospitals and other healthcare institutions in non-outbreak situations in Western

Madeleine Dulon; Frank Haamann; Claudia Peters; Anja Schablon; Albert Nienhaus

2011-01-01

60

Family eczema-history in 2-year olds with eczema; a prospective, population-based study. The PACT-study, Norway  

Microsoft Academic Search

Background  A maternal line of inheritance regarding eczema has been described in several studies, whereas others find associations to\\u000a both a maternal as well as a paternal line of inheritance. When studying family history of eczema symptoms, cohort studies\\u000a including siblings are rare. Time point for assessing family eczema-history could be of importance when studying the associations\\u000a between family eczema-history and

Marit Saunes; Torbjørn Øien; Ola Storrø; Roar Johnsen

2011-01-01

61

Atopic eczema: its impact on the family and financial cost  

Microsoft Academic Search

OBJECTIVETo evaluate the impact of childhood atopic eczema on families and assess the personal financial cost of its management.DESIGNCross sectional survey.SETTINGPaediatric dermatology and paediatric diabetology outpatient clinics.PATIENTSParents of 48 randomly selected children with atopic eczema and 46 with insulin dependent diabetes mellitus.MAIN OUTCOME MEASURESThe impact on family score, the reported cost of relevant medical treatments, medical consultations, relevant hospitalisation, and

John C Su; Andrew S Kemp; George A Varigos; Terence M Nolan

1997-01-01

62

A Prospective Study of the Case-Notes of MRSA-Positive Patients: A Vehicle of MRSA Spread  

PubMed Central

INTRODUCTION Methicillin-resistant Staphylococcus aureus (MRSA) has received much publicity and remains a major problem for the health service. The aim of this study was to determine whether case-notes of MRSA-positive patients can act as a vehicle for MRSA transmission. PATIENTS AND METHODS A prospective study was performed of patients with active MRSA infection identified from a microbiology department database. Two swabs were taken from the cover of the case-notes and the page with the most recent entry for identification of MRSA using MRSA ID (Chromogenic agar medium), Pastorex and DNase tests. Positive case-notes were re-swabbed 96 h later. RESULTS A total of 50 MRSA-positive patients were identified from medical, surgical, high dependency and intensive care Three sets of notes were MRSA positive (3/50; 6%). None of the positive case-notes was positive on re-swabbing at 96 h. CONCLUSIONS Case-notes of MRSA-positive patients can act as carriers of MRSA with the potential to spread MRSA to both healthcare and non-healthcare workers without direct contact with infected patients. We recommend extending the universal precautions to the handling of case-notes belonging to MRSA-infected patients.

Hamza, N; Bazoua, G; Al-Shajerie, Y; Kubiak, E; James, P; Wong, C

2007-01-01

63

Control of MRSA infection and colonisation in an intensive care unit by GeneOhm MRSA assay and culture methods  

PubMed Central

Background Methicillin-resistant Staphylococcus aureus (MRSA) is one of the major nosocomial pathogens. Due to the diffusion of MRSA strains in both hospital and community settings, prevention and control strategies are receiving increased attention. Approximately 25% to 30% of the population is colonised with S. aureus and 0.2% to 7% with MRSA. The BD GeneOhm MRSA real-time PCR assay offers quicker identification of MRSA-colonised patients than do culture methods. Methods Ninety-five patients admitted to the Intensive Care Unit of IRCCS Policlinico San Matteo of Pavia (Italy) for a period > 24 h were screened for MRSA colonisation with both the culture method and the GeneOhm assay. Results Of the 246 nasal swabs collected from 95 patients, 36 samples were found to be positive by both methods (true-positive). 30% of colonised patients had developed the MRSA infection. Conclusion Our results show that the GeneOhm MRSA assay is a valuable diagnostic tool for detecting MRSA quickly in nasal swabs. This study confirms that colonisation represents a high risk factor for MRSA infection, and that good MRSA surveillance in an Intensive Care Unit is therefore an excellent way to prevent MRSA infection.

2009-01-01

64

Classification of atopic hand eczema and the filaggrin mutations.  

PubMed

Hand eczema is a common disease with various risk factors of which atopic dermatitis is known to be one of the most important. Recently, two mutations in the gene coding for filaggrin, a protein important for the skin barrier, have repeatedly been shown to be associated with atopic dermatitis. Moreover, one study point towards an association between the filaggrin null alleles and the subgroup of patients having both hand eczema and atopic dermatitis. For the remainder of hand eczema patients, still unknown genetic risk factors exist. We propose that in future, classification of atopic hand eczema should distinguish between patients with and without the filaggrin null alleles and to further differentiate between associations with type I allergy, type IV allergy and exposure to irritants, respectively. Furthermore, we suggest future studies of atopic hand eczema to analyse for the filaggrin mutations. We believe this will increase the possibility of subgrouping this otherwise heterogenic disease and thereby enable a better phenotype-genotype characterization of hand eczema. This could improve the preventive initiatives, secure better information of patients about the prognosis for their disease, and possibly enable targeted treatment. PMID:18976374

Giwercman, Charlotte; Lerbaek, Anne; Bisgaard, Hans; Menné, Torkil

2008-11-01

65

Sleep and neurocognitive functioning in children with eczema.  

PubMed

Sleep disruption in childhood is associated with clearly defined deficits in neurocognition and behaviour. Childhood eczema is also a potent cause of sleep disruption though it is unknown whether it too results in neurocognitive deficits. To test this hypothesis, neurocognitive (WISC-IV), parental-reported sleep quality (Sleep Disturbance Scale of Children (SDSC)) and overnight polysomnographic (PSG) data were collected in 21 children with eczema and 20 healthy controls (age range 6-16 years). Children with eczema had worse sleep quality on both PSG (notably increased nocturnal wakefulness, a higher number of stage shifts and a longer latency to REM onset) and parental report. In addition, they demonstrated significant neurocognitive deficits (especially verbal comprehension, perceptual reasoning and to a lesser extent working memory) with a composite Full Scale IQ 16 points lower than controls. Parental reported sleep problems but not PSG parameters were correlated with reduced neurocognitive performance. However, hierarchical regression analyses revealed that eczema status was predictive while sleep fragmentation (parental or PSG) was not predictive of neurocognitive performance. As this is the first study to systematically examine neurocognitive functioning in children with eczema and given the finding of significant deficits it merits replication especially given the prevalence of the condition. The unanswered question is whether these cognitive deficits normalise with effective eczema treatment and if this is mediated by improvements in sleep architecture. PMID:23353660

Camfferman, Danny; Kennedy, J Declan; Gold, Michael; Simpson, Carol; Lushington, Kurt

2013-08-01

66

Impact of hand eczema severity on quality of life  

PubMed Central

Background: Hand eczema is a common disease seen in dermatological practice comprising of a spectrum ranging from mild disease to a severe distressing and chronic course with a negative impact on the quality of life. Aim: To assess the impact of hand eczema severity on quality of life. Materials and Methods: Patients with hand eczema were enrolled in a prospective study. Disease severity was assessed by hand eczema severity index (HECSI) score and quality of life by dermatology life quality index (DLQI) questionnaire. Results: Forty-six patients participated of which 22 (47.8%) were males and 24 (52.2%) females. The commonest age group affected among men and women was 50-59 years (31.8%) and 40-49 years (41.7%) respectively. History of atopy was found in 23.9% and 63% had persistent disease. In 28 (60.9%), the trigger was washing soaps and detergents of which 21 (87.5%) were housewives. Of those employed, 27.7% reported loss of work days. The mean HECSI score was 14.46 (S.D = 20.98) and mean DLQI score was 9.54 (S.D = 5.62). Gender, age, occupation and duration of disease did not significantly affect the quality of life or disease severity. Increased episodes of eczema (>4 episodes/year) showed a statistically significant correlation with DLQI (P value = 0.021). There was no significant correlation between HECSI score and DLQI in this study. Conclusion: Majority of the patients with hand eczema had a significant impairment of their quality of life. The impairment of quality of life in this study was mainly dependent on increased frequency of the eruptions and not on hand eczema severity.

Charan, Ujwala Priya; Peter, C. V. Dincy; Pulimood, Susanne A.

2013-01-01

67

Anti-infectious agents against MRSA.  

PubMed

Clinically useful antibiotics, ?-lactams and vancomycin, are known to inhibit bacterial cell wall peptidoglycan synthesis. Methicillin-resistant Staphylococcus aureus (MRSA) has a unique cell wall structure consisting of peptidoglycan and wall teichoic acid. In recent years, new anti-infectious agents (spirohexaline, tripropeptin C, DMPI, CDFI, cyslabdan, 1835F03, and BPH-652) targeting MRSA cell wall biosynthesis have been discovered using unique screening methods. These agents were found to inhibit important enzymes involved in cell wall biosynthesis such as undecaprenyl pyrophosphate (UPP) synthase, FemA, flippase, or UPP phosphatase. In this review, the discovery, the mechanism of action, and the future of these anti-infectious agents are described. PMID:23262449

Koyama, Nobuhiro; Inokoshi, Junji; Tomoda, Hiroshi

2012-01-01

68

Therapeutic patient education in atopic eczema.  

PubMed

Therapeutic patient education (TPE) is a patient-centred process that entails the transfer of skills (e.g. self-management, treatment adaptation) from a trained healthcare professional to patients and/or their carers. TPE has been shown to help improve adherence, prevent complications, and improve quality of life (QoL) in chronic illnesses such as diabetes, asthma and cardiovascular disease. Recently, TPE recommendations for patients with atopic eczema have been proposed. TPE is a four-step process: understanding the patient's knowledge, beliefs and hopes; setting age-appropriate educational objectives; helping the patient (or carer) to acquire skills; and assessing the success of the programme. TPE programmes always involve a multidisciplinary team of healthcare professionals, including nurses, psychologists, doctors and dieticians who are expert in the disease area. TPE should be offered to (never forced upon) any patient who has experienced treatment failure, or to families who feel they lack social support. High-quality TPE programmes should be evidence-based, tailored to a patient's individual educational and cultural background (rather than being standardized in form and content), and have well-defined content and activities. PMID:24720486

Barbarot, S; Stalder, J F

2014-07-01

69

A plea to expunge the word “eczema” from the lexicon of dermatology and dermatopathology  

Microsoft Academic Search

Despite its common use for centuries, the term “eczema” has never been defined in a repeatable way. Although there have been innumerable attempts to do that, the word eczema still lacks specific meaning. Dermatology and dermatopathology will come of age when the word eczema is no longer used.

A. Bernard Ackerman; Anna Ragaz

1982-01-01

70

A Holistic Approach to MRSA Eradication in Critically Ill Patients with MRSA Pneumonia  

Microsoft Academic Search

Background:  The number of Methicillin-resistant Staphylococcus aureus (MRSA) pneumonia cases is increasing in many European countries. In this observational study in one medical and three surgical\\u000a ICUs multiple interventions for the treatment and eradication of nosocomial MRSA-pneumonia were used.\\u000a \\u000a \\u000a \\u000a Patients and Methods:  Twenty-one critically ill patients (age: 59 14 years, 15 males\\/6 females, 18 ventilator-associated, 3 nosocomial, clinical\\u000a pulmonary infection score >

C. Wenisch; H. Laferl; M. Szell; K. H. Smolle; A. Grisold; G. Bertha; R. Krause

2006-01-01

71

Methicillin resistant Staphylococcus aureus (MRSA) in the intensive care unit  

PubMed Central

Methicillin resistant Staphylococcus aureus (MRSA) is a major nosocomial pathogen that causes severe morbidity and mortality worldwide. MRSA strains are endemic in many American and European hospitals and account for 29%–35% of all clinical isolates. Recent studies have documented the increased costs associated with MRSA infection, as well as the importance of colonisation pressure. Surveillance strategies have been proposed especially in high risk areas such as the intensive care unit. Pneumonia and bacteraemia account for the majority of MRSA serious clinical infections, but intra-abdominal infections, osteomyelitis, toxic shock syndrome, food poisoning, and deep tissue infections are also important clinical diseases. The traditional antibiotic therapy for MRSA is a glycopeptide, vancomycin. New antibiotics have been recently released that add to the armamentarium for therapy against MRSA and include linezolid, and quinupristin/dalfopristin, but cost, side effects, and resistance may limit their long term usefulness.

Haddadin, A; Fappiano, S; Lipsett, P

2002-01-01

72

Efficacy of oral hygiene products against MRSA and MSSA isolates  

Microsoft Academic Search

Sir, Clinical experience has shown that oropharyngeal carriage of methicillin-resistant Staphylococcus aureus (MRSA) can be difficult to eradicate.1 Oral carriage of MRSA may serve as a reservoir for colonization of other body sites, or cross-infection to other patients or healthcare workers.2 Eradication of throat carriage of MRSA has been achieved using topical chlorhexidine (0.2%), in addition to normal control measures

A. J. Smith; D. Morrison; Douglas Robertson; Michael K. Tang; Z. Al-Doori

2010-01-01

73

Acute MRSA Sinusitis with Intracranial Extension and Marginal Vancomycin Susceptibility  

PubMed Central

Methicillin resistant Staphylococcus aureus (MRSA) is increasingly being described as a cause of acute sinusitis. We present a patient with acute MRSA sinusitis complicated by rapid intracranial extension, marginal vancomycin susceptibility (MIC = 2?mg/L), delayed drainage of intracranial abscess, and subsequent development of rifampin resistance. Given the relatively high risk of intracranial extension of severe acute bacterial sinusitis and high mortality associated with invasive MRSA infections, we suggest early surgical drainage of intracranial abscesses in these circumstances. We believe this is important given the limited intracranial penetration of currently available treatment options for MRSA, especially those with a vancomycin minimal inhibitory concentration (MIC) of ?2?mg/L.

Kumar, Parvathi S.; Cunnion, Kenji M.

2013-01-01

74

Rapid methods for detection of MRSA in clinical specimens.  

PubMed

Antimicrobial susceptibility test methods such as disk diffusion, broth microdilution, and oxacillin screen plate require 24 h of incubation after having the organism growing in pure culture. Rapid and accurate identification of MRSA isolates is essential not only for patient care, but also for effective infection control programs to limit the spread of MRSA. In the last few years, several commercial rapid tests for detection of MRSA directly from nasal swabs and blood cultures have been developed for use in clinical laboratories. Real-time PCR and other molecular tests are gaining popularity as MRSA screening tests to identify patients who are candidates for contact precaution at the time of admission decreasing the risk for nosocomial transmission. These new methodologies have the advantage of a lower turnaround time than that of traditional culture and susceptibility testing and they are capable of detecting MRSA directly from nasal or wound swabs allowing rapid identification of colonized or infected patients. In addition, molecular methods able to detect and differentiate S. aureus and MRSA (SA/MRSA) directly from blood cultures are becoming a useful tool for rapid detection of bacteremia caused by MSSA and MRSA. This review focuses on the procedures for performing testing using rapid methods currently available for detection of MRSA directly from clinical specimens. PMID:24085689

Palavecino, Elizabeth L

2014-01-01

75

Pimecrolimus cream in the management of patients with atopic eczema  

PubMed Central

Atopic eczema is a common pediatric skin disorder. This review examines the use of pimecrolimus cream in the treatment of acute and chronic stages of the disease. The standard therapy is the treatment of acute flares with topical medications including pimecrolimus. The use of pimecrolimus cream for the first sign and symptoms of atopic eczema reduces the occurrence of flares as defined by the need for topical corticosteroids. The side effects of pimecrolimus cream are mild without any increase of infections or systemic immune suppression.

Spergel, Jonathan M

2009-01-01

76

Nutritional hazards of elimination diets in children with atopic eczema  

Microsoft Academic Search

The intake of nutrients over a five day period was studied in 23 children whose atopic eczema was being treated by the avoidance of multiple foods. The results were compared with those from 23 healthy control children not on a diet. Significantly low intakes of calcium were discovered in 13 patients but not in controls. Avoidance of multiple foods is

T J David; E Waddington; R H Stanton

1984-01-01

77

Prospective Comparison of the Clinical Impacts of Heterogeneous Vancomycin-Intermediate Methicillin-Resistant Staphylococcus aureus (MRSA) and Vancomycin-Susceptible MRSA  

Microsoft Academic Search

Although methicillin (meticillin)-resistant Staphylococcus aureus (MRSA) strains with reduced susceptibility to vancomycin (RVS-MRSA; including vancomycin-intermediate S. aureus (VISA) and heterogeneous VISA (hVISA)) have been linked with vancomycin treatment failure, it is unclear whether they are more pathogenic than vancomycin-susceptible MRSA (VS-MRSA). We prospectively assessed patients with clinical MRSA isolates during a 10-month period to determine clinical status (infection versus colonization)

K. C. Horne; B. P. Howden; E. A. Grabsch; M. Graham; P. B. Ward; S. Xie; B. C. Mayall; P. D. R. Johnson; M. L. Grayson

2009-01-01

78

Contact Eczema Caused by True Teak (Tectona Grandis)  

PubMed Central

An epidemiological study of occupational contact eczema in a furniture factory is presented. The localization, distribution, and clinical features of the skin lesions were characteristic of contact eczema caused by a sensitizing or irritating dust. True teak—Tectona grandis—was the cause of the skin condition. That teak is a fairly potent sensitizer and also contains primary irritants is fully confirmed by the present study. About half the employees who were heavily exposed to teak dust suffered from eczema and/or severe itching. Only 8% of those with slight exposure to teak dust experienced skin symptoms. Patch tests with native teak dust moistened with water were applied on 10 “controls” and 112 workers who were exposed to teak in various working procedures. Moistened teak dust produced toxic reactions in 20·5%, while native teak dust did not have primary irritant effects and was, therefore, considered to be the substance of choice for patch testing; 18·7% of the workers showed an allergic skin reaction to native teak dust. The diagnosis of allergic contact eczema was made in 12·5%, and 6·2% were considered to have latent allergy. Primary irritant (contact) eczema was considered to be present in four individuals who had experienced acute, transitory, eczematous eruptions during the hot part of the summer when they perspired freely. In these cases the patch test to native teak dust was negative. Desensitization or “hardening” was observed in four workers. In most cases the skin lesions were not severe enough to cause sickness absence. The cause of the relatively high percentage of sensitization to teak among the workers in the factory is discussed. The importance of suitable prophylactic measures is stressed.

Krogh, H. K.

1962-01-01

79

[The effectiveness of hand hygiene products on MRSA colonization of health care workers by using CHROMagar MRSA].  

PubMed

The aims of this study were; to investigate the hand hygiene compliance of the health care workers (HCWs) during their routine patient care, to determine the methicillin-resistant Staphylococcus aureus (MRSA) hand colonization of the HCWs, to investigate the effect of different hand hygiene products on MRSA colonization and to evaluate the effectiveness of chromogenic agar for detecting MRSA. HCWs were investigated during their routine patient care and hand cultures were taken before and after hand wash/hygiene. Two different techniques were used to obtain the hand cultures: fingertip method (CHROMagar MRSA containing HygiSlide); and direct swab method and then inoculation to CHROMagar MRSA media. MRSA strains grown on those cultures were confirmed with conventional methods. A total of 100 HCWs (of them 61 were female; mean age: 32.7 ± 5.2 years; age range: 25-51 years) involving physicians (n= 33), nurses (n= 38) and health care assistants (n= 29), were included in the study. MRSA was detected in 39% and 11% before hand hygiene and in 13% and 6% after hand hygiene, with HygiSlide CHROMagar media and with CHROMagar in plate media, respectively. No difference were found regarding clinics, occupations, or the type of patient handling in those HCWs who were positive (n= 13) for MRSA colonization following hand hygiene, and those who were negative (n= 26). However, the type of the hand hygiene product used exhibited a statistical difference. None of the seven HCWs who used alcohol based hand rub revealed growth in the second culture while 10 of 19 (53%) HCWs who used soap and three of 13 (23%) HCWs who used chlorhexidine were still colonized with MRSA. In terms of reduction in the MRSA counts, the most effective one was the alcohol based hand rub while the soap was the least, since seven of 19 (37%) HCWs who used soap showed no reduction at all in the MRSA counts. A high ratio of hand colonization with MRSA was detected in our hospital staff (39%). It was shown that the colonization could be reduced significantly (with a rate of 66%) with hand hygiene. Alcohol based hand rub was found to be the most effective method in hand hygiene. The fingertip technique was found to be superior to inoculation to plate media for obtaining hand cultures and CHROMagar MRSA media was found to be rapid, effective and practical for detecting the MRSA hand colonization. PMID:22639312

Koçak Tufan, Zeliha; Irmak, Hasan; Bulut, Cemal; Cesur, Salih; K?n?kl?, Sami; Demiröz, Ali Pekcan

2012-04-01

80

Early eczema and the risk of childhood asthma: a prospective, population-based study  

PubMed Central

Background Severe eczema in young children is associated with an increased risk of developing asthma and rhino-conjunctivitis. In the general population, however, most cases of eczema are mild to moderate. In an unselected cohort, we studied the risk of current asthma and the co-existence of allergy-related diseases at 6 years of age among children with and without eczema at 2 years of age. Methods Questionnaires assessing various environmental exposures and health variables were administered at 2 years of age. An identical health questionnaire was completed at 6 years of age. The clinical investigation of a random subsample ascertained eczema diagnoses, and missing data were handled by multiple imputation analyses. Results The estimate for the association between eczema at 2 years and current asthma at 6 years was OR=1.80 (95% CI 1.10-2.96). Four of ten children with eczema at 6 years had the onset of eczema after the age of 2 years, but the co-existence of different allergy-related diseases at 6 years was higher among those with the onset of eczema before 2 years of age. Conclusions Although most cases of eczema in the general population were mild to moderate, early eczema was associated with an increased risk of developing childhood asthma. These findings support the hypothesis of an atopic march in the general population. Trial registration The Prevention of Allergy among Children in Trondheim study has been identified as ISRCTN28090297 in the international Current Controlled Trials database

2012-01-01

81

Fish consumption, fish atopy and related heavy metals in childhood eczema.  

PubMed

Due to increasing worldwide water pollution, fish might be a source of excessive zinc, mercury, arsenic or manganese intake. The aim of this study was to evaluate if fish atopy/sensitization and fish consumption behavior are associated with eczema severity and blood levels of the 4 heavy metals.One-hundred and nineteen patients with eczema and 43 patients with miscellaneous non-eczema skin diseases were studied. There were no differences in average weekly fish consumption and blood levels of the 4 heavy metals between eczema and non-eczema groups. Blood levels of these metals were generally within the upper limits of local reference ranges in all these patients. In eczema patients, freshwater fish consumption behavior in days-per-week was correlated with blood arsenic and mercury levels (rho=0.17, p<0.01 for both metals), but not with zinc or manganese. Levels of arsenic and mercury were also correlated with days of seawater fish consumption per week (arsenic: 0.38, mercury: 0.24, p <0.05).Fish sensitization was present in 25% of patients with eczema. Nevertheless, there was no difference in terms of fish consumption behavior, eczema severity, quality of life, and heavy metal levels between eczema patients with or without fish sensitization. We conclude that without exceeding local normal reference ranges, blood arsenic and mercury levels correlated with fish consumption behavior. There is no evidence to suggest that fish sensitization is associated with more severe eczema (bad for eczema), or that patients have milder eczema with more days of fish consumption (good for eczema). PMID:22947908

Hon, Kam Lun; Lui, Heike; Wang, Shuxin Susan; Lam, Hugh Simon; Leung, Ting Fan

2012-09-01

82

Community-associated MRSA: what makes them special?  

PubMed

While infections with methicillin-resistant Staphylococcus aureus (MRSA) were traditionally restricted to the hospital setting, novel MRSA strains emerged over the last two decades that have the capacity to infect otherwise healthy people outside of the hospital setting. These community-associated (CA-)MRSA strains combine methicillin resistance with enhanced virulence and fitness. Interestingly, CA-MRSA strains emerged globally and from different backgrounds, indicating that the "trade-off" between maintaining sufficient levels of methicillin resistance and obtaining enhanced virulence at a low fitness cost was achieved on several occasions in convergent evolution. However, frequently this process comprised similar changes. First and foremost, all CA-MRSA strains typically carry a novel type of methicillin resistance locus that appears to cause less of a fitness burden. Additionally, acquisition of specific toxin genes, most notably that encoding Panton-Valentine leukocidin (PVL), and adaptation of gene expression of genome-encoded toxins, such as alpha-toxin and phenol-soluble modulins (PSMs), further contributed to the evolution of CA-MRSA. Finally, the exceptional epidemiological success of the USA300 CA-MRSA clone in particular may have been due to yet another gene acquisition, namely that of the speG gene, which is located on the arginine catabolic mobile element (ACME) and involved in detoxifying harmful host-derived polyamines. PMID:23517691

Otto, Michael

2013-08-01

83

Outcome of MRSA carriers in neurological early rehabilitation  

PubMed Central

Background Colonization with MRSA is believed to have deteriorating effects on neurological rehabilitation patients because MRSA carriers need to be isolated. Methods Medical records of neurological early rehabilitation patients (most of them after stroke) admitted to a large rehabilitation facility in Northern Germany in 2010 have been carefully reviewed with respect to MRSA status, outcome variables (functional independence), morbidity, and length of stay (LOS). Results 74/569 (13.0%) patients were MRSA positive on admission. MRSA carriers had a significantly longer LOS in early neurological rehabilitation (63.7 (37.1) vs. 25.8 (24.5) days, p?MRSA positive patients (BI 25.5 (21.2) vs. 47.4 (31.0), p?MRSA positive group due to longer LOS. Conclusions Functional recovery of MRSA carriers in early neurological rehabilitation is worse than in MRSA negative patients. Poorer outcome is not resulting from isolation (less therapy) but from functional status and higher morbidity on admission.

2014-01-01

84

Survival of epidemic strains of healthcare (HA-MRSA) and community-associated (CA-MRSA) meticillin-resistant Staphylococcus aureus (MRSA) in river-, sea- and swimming pool water  

Microsoft Academic Search

The aim of this study was to examine the survival dynamics of several epidemic healthcare (HA) and community-associated (CA) meticillin-resistant Staphylococcus aureus (MRSA) in river, sea and swimming pool waters. Six different phage-types of HA-MRSA (Irish 1, Irish 2, EMRSA 15, EMRSA 16, distinct type and non-typable), as well as a community-associated MRSA (CA-MRSA), were examined in this study. Two

Ola Tolba; Anne Loughrey; Colin E. Goldsmith; B. Cherie Millar; Paul J. Rooney; John E. Moore

2008-01-01

85

Comparative evaluation of a rapid MRSA detection assay based on multiplex real-time PCR versus MRSA screening cultures containing egg yolk.  

PubMed

Although the Centers for Disease Control and Prevention (CDC) has been recommending the performance of active surveillance culture (ASC) for the prevention of methicillin-resistant Staphylococcus aureus (MRSA) infections and their control since the guideline was issued in 2006, many variant types of MRSA with various characteristics have been found recently. As this change in MRSA characteristics makes it harder to screen MRSA only by cultures, it is expected that ASC will not be sufficient for the prevention of MRSA infections or MRSA infection control. We evaluated the comparative utility of the BD GeneOhm MRSA assay (a rapid MRSA detection test based on a multiplex real-time polymerase chain reaction [PCR] assay; Becton Dickinson, Fukushima, Japan) and MRSA screening cultures containing egg yolk. The results of the BD GeneOhm MRSA assay were as follows: all MRSA strains were positive, including one strain which became positive by retest; all methicillin-resistant S. epidermidis (MRSE) strains and methicillin-sensitive S. epidermidis (MSSE) strains were negative; 11 of 12 methicillin-sensitive S. aureus (MSSA) strains were negative, while 1 strain was positive; ATCC 33591 was positive, and ATCC 29213 was negative. The sensitivity and specificity of the BD GeneOhm MRSA assay were 100% and 97.4%, respectively. Nine egg yolk reaction-negative MRSA strains were found in 50 MRSA strains, and all MRSE, MSSA, and MSSE strains were denied as MRSA on Pourmedia MRSA II (Eiken Chemical, Tokyo, Japan) after 24-h or 48-h incubation at 35 degrees C. The sensitivity and specificity of Pourmedia MRSA II were 82% and 100%, respectively. Similar results were obtained with some other cultures containing egg yolk. PMID:19688248

Sumitani, Yuko; Kobayashi, Yoshio

2009-08-01

86

Evolution of Staphylococcus aureus and MRSA during outbreaks.  

PubMed

Investigation of Staphylococcus aureus outbreaks, and particularly those due to methicillin-resistant S. aureus (MRSA) in hospitals, can identify infection reservoirs and prevent further colonization and infection. During outbreaks, S. aureus genomes develop single nucleotide polymorphisms (SNPs), small genetic rearrangements, and/or acquire and lose mobile genetic elements (MGE) encoding resistance and virulence genes. Whole genome sequencing (WGS) is the most powerful method for discriminating between related isolates and deciding which are involved in an outbreak. Isolates with only minor variations are detectable and can identify MRSA transmission routes and identify reservoirs. Some patients may carry 'clouds' of related isolates, and this has consequences for how we interpret the data from outbreak investigations. Different clones of MRSA are evolving at different rates, influencing their typability. S. aureus genome variation reveals the importance of antibiotic resistance in the long term evolution of successful hospital clones, contributing to strategies to prevent the spread of successful MRSA clones. PMID:23665384

Lindsay, Jodi A

2014-01-01

87

Predicting Risk for Death from MRSA Bacteremia1  

PubMed Central

Methicillin-resistant Staphylococcus aureus (MRSA) bacteremia is often fatal. To determine predictors of risk for death, we conducted a retrospective cohort study. We examined 699 episodes of MRSA bacteremia involving 603 patients admitted to an academic medical center in New York City during 2002–2007. Data came from chart reviews, hospital databases, and recultured frozen MRSA specimens. Among the 699 episodes, 55 were caused by vancomycin–intermediate resistant S. aureus strains, 55 by heteroresistant vancomycin-intermediate S. aureus strains, and 589 by non–vancomycin-resistant strains; 190 (31.5%) patients died. We used regression risk analysis to quantify the association between clinical correlates and death. We found that older age, residence in a nursing home, severe bacteremia, and organ impairment were independently associated with increased risk for death; consultation with an infectious disease specialist was associated with lower risk for death; and MRSA strain types were not associated with risk for death.

Kleinman, Lawrence C.; Lacerda de la Cruz, Eliesel G.; Jenkins, Stephen G.

2012-01-01

88

A practical guide to community-acquired MRSA.  

PubMed

As the number of CA-MRSA skin and soft tissue infections continues to grow, it's important to know which patients are at greatest risk and which evidence-based treatment protocols to turn to when needed. PMID:24288707

Sastre, Aristides; Roberts, Paul F; Presutti, R John

2013-11-01

89

Clonal dissemination of two MRSA strains in Germany.  

PubMed Central

Clonal dissemination of two different MRSA strains, both clumping factor negative, has been observed in Germany for more than a year. Both strains possess the mec-A determinant and each exhibits a characteristic genomic DNA fragment pattern. One strain has spread in the north, the other in the south-west of Germany. Intensive care units are mainly affected by MRSA-infections and probably play a special role in further intra- and inter-hospital spread. Images Fig. 3

Witte, W.; Cuny, C.; Braulke, C.; Heuck, D.

1994-01-01

90

Blue Light Phototherapy Kills Methycillin Resistant Staphylococcus Aureus (MRSA)  

NASA Astrophysics Data System (ADS)

Background: Methycillin resistant staphylococcus aureus (MRSA) bacteria continue to defy most available antibiotics. As a result infections with MRSA remain a growing public health concern. As a paradigm shift and a significant departure from the on-going trend to develop stronger drug-based therapies, we studied the effect of 405 nm and 470 nm wavelengths of blue light on two strains of MRSA-US-300 strain of CA-MRSA and the IS853 strain of HA-MRSA-in vitro. Methods: We cultured and plated each strain, following which bacteria colonies were irradiated with 0, 1, 3, 5, 7, 9, 11, 13, 15, 17, 19, 25, 30, 35, 40, 45, 50, 55, or 60 Jcm-2 energy densities-just once. Specimens were incubated at 35° C for 24 h. Then, digital images obtained were quantified to obtain colony counts and the aggregate area occupied by bacteria colonies. Results: Each wavelength produced a statistically significant dose-dependent reduction in both the number and the aggregate area of colonies formed by each bacteria strain (P<0.001). Maximum eradication of the US-300 (92.1%) and the IS-853 colonies (93.5%) was achieved within 10 minutes of irradiation with each wavelength. The longer the irradiation the more bacteria were eradicated. However, the effect was non-linear as increases of energy densities between 1.0 and 15 J cm-2 resulted in more bacteria death than similar increases between 15 J cm-2 and 60 J cm-2. Conclusion: At low doses, blue light photo-destroys HA-MRSA and CA-MRSA in vitro; raising the prospect that phototherapy may be an effective clinical tool in the on-going effort to stem MRSA infections.

Enwemeka, Chukuka S.

2010-05-01

91

The burden of MRSA in four German university hospitals  

Microsoft Academic Search

In the last few years, a dramatic increase of Methicillin-resistant Staphylococcus aureus (MRSA) detection in German hospitals can be recognized. Under this enormous pressure it is very important for infection control teams to assess the epidemiologic situation correctly. Therefore, a prospective multicenter hospital-based surveillance of MRSA cases was executed in four university hospitals with 1017–1333 beds in Germany. Routine surveillance

Iris F. Chaberny; Stefan Ziesing; Frauke Mattner; Sina Bärwolff; Christian Brandt; Tim Eckmanns; Henning Rüden; Dorit Sohr; Klaus Weist; Petra Gastmeier

2005-01-01

92

What's new in atopic eczema? An analysis of systematic reviews published in 2009-2010.  

PubMed

This review provides a summary of key findings from 18 systematic reviews on atopic eczema, published or indexed between January 2009 and 24 August 2010. There was no good evidence on the possible benefit of organic food consumption and eczema. Maternal intake of fish or fish oil may be associated with a reduced risk of eczema in offspring, although further studies are needed. There is some evidence that partially hydrolysed infant formulas rather than standard formulas may be associated with a reduced risk of eczema in infants, but there are shortcomings in the existing evidence. An inverse relationship has been found between gliomas/acute lymphoblastic leukaemia and allergic disease/eczema, but there appears to be no association between multiple sclerosis and eczema. Attention deficit hyperactivity disorder does appear to be associated with eczema, but there is no evidence of a causal link. The risk of eczema seems to be increased in urban compared with rural areas. Some new evidence has suggested superiority of 1% pimecrolimus over potent and mild corticosteroids at 6?months but not 12?months, and there is some evidence for superiority of 0.03% and 0.1% tacrolimus over 1% pimecrolimus. An updated Cochrane Review still found no evidence of a benefit from any form of antistaphylococcal treatment in managing clinically infected or uninfected eczema. The evidence base is poor for bath emollients, occlusive treatments (e.g., wet and dry wraps) and woven silk clothing in treating eczema. In general, the methods used in most systematic reviews of eczema need to be reported more clearly, especially with regard to a more vigorous quality assessment of included studies. Included studies are frequently heterogeneous, proxy reporting is common, and appropriate disease definitions are often lacking. Better adherence to existing guidance on trial reporting and prospective registration of clinical trials may help improve the quality of studies. PMID:21718344

Shams, K; Grindlay, D J C; Williams, H C

2011-08-01

93

Risk factors for developing clinical infection with methicillin-resistant Staphylococcus aureus (MRSA) amongst hospital patients initially only colonized with MRSA  

Microsoft Academic Search

In hospital outbreaks of methicillin-resistant Staphylococcus aureus (MRSA) many patients are initially colonized without infection. The reasons why some progress to infection while others do not are not known. A cohort of 479 hospital patients, initially only colonized with MRSA, was followed prospectively for the development of MRSA infection. Risk factors for progression to infection were assessed using Cox proportional

R. Coello; J. R. Glynn; C. Gaspar; J. J. Picazo; J. Fereres

1997-01-01

94

A randomised study of “wet wraps” versus conventional treatment for atopic eczema  

Microsoft Academic Search

Aims: To compare two treatments in common usage for children with atopic eczema: “wet wrap” bandages versus conventional topically applied ointments.Methods: A total of 50 children (age 4–27 months) with moderate to severe eczema were randomised to one or other treatment. Two research nurses supervised the study. The first gave advice and support, and the second, blinded to the treatment

D Hindley; G Galloway; J Murray; L Gardener

2006-01-01

95

Homoeopathic versus Conventional Therapy for Atopic Eczema in Children: Medical and Economic Results  

Microsoft Academic Search

Background: One of five children visiting a homoeopathic physician is suffering from atopic eczema. Objective: To examine the effectiveness, safety and costs of homoeopathic versus conventional treatment in usual care. Methods: In a prospective multicentre comparative observational non-randomised study, 135 children (homoeopathy n = 48 vs. conventional n = 87) with mild to moderate atopic eczema were included. The primary

Claudia M. Witt; Benno Brinkhaus; Daniel Pach; Thomas Reinhold; Katja Wruck; Stephanie Roll; Tanja Jäckel; Doris Staab; Karl Wegscheider; Stefan N. Willich

2009-01-01

96

The antioxidant activity of Chinese herbs for eczema and of placebo herbs — I  

Microsoft Academic Search

A standardized mixture of Chinese herbs has recently been demonstrated to be an effective treatment for chronic atopic eczema in placebo controlled trials in the UK. Aqueous decoctions of this formulated mixture (PSE 222), the placebo mixture, and their component herbs were examined for antioxidant activity to determine whether antioxidant activity could account for the anti-eczema activity. Two measures of

Andrew J. Kirby; Richard J. Schmidt

1997-01-01

97

Suspected facial eczema in sheep in the central Orange Free State.  

PubMed

Facial eczema is known to occur in the Humansdorp district of the Cape Province. During June 1982-January 1984, 5 outbreaks of hepatogenous photosensitivity occurred in sheep in central districts of the Orange Free State. In one of these outbreaks a diagnosis of suspected facial eczema was made histologically. PMID:6543453

De Wet, J A; Erasmus, J A

1984-12-01

98

Intraindividual genome expression analysis reveals a specific molecular signature of psoriasis and eczema.  

PubMed

Previous attempts to gain insight into the pathogenesis of psoriasis and eczema by comparing their molecular signatures were hampered by the high interindividual variability of those complex diseases. In patients affected by both psoriasis and nonatopic or atopic eczema simultaneously (n = 24), an intraindividual comparison of the molecular signatures of psoriasis and eczema identified genes and signaling pathways regulated in common and exclusive for each disease across all patients. Psoriasis-specific genes were important regulators of glucose and lipid metabolism, epidermal differentiation, as well as immune mediators of T helper 17 (TH17) responses, interleukin-10 (IL-10) family cytokines, and IL-36. Genes in eczema related to epidermal barrier, reduced innate immunity, increased IL-6, and a TH2 signature. Within eczema subtypes, a mutually exclusive regulation of epidermal differentiation genes was observed. Furthermore, only contact eczema was driven by inflammasome activation, apoptosis, and cellular adhesion. On the basis of this comprehensive picture of the pathogenesis of psoriasis and eczema, a disease classifier consisting of NOS2 and CCL27 was created. In an independent cohort of eczema (n = 28) and psoriasis patients (n = 25), respectively, this classifier diagnosed all patients correctly and also identified initially misdiagnosed or clinically undifferentiated patients. PMID:25009230

Quaranta, Maria; Knapp, Bettina; Garzorz, Natalie; Mattii, Martina; Pullabhatla, Venu; Pennino, Davide; Andres, Christian; Traidl-Hoffmann, Claudia; Cavani, Andrea; Theis, Fabian J; Ring, Johannes; Schmidt-Weber, Carsten B; Eyerich, Stefanie; Eyerich, Kilian

2014-07-01

99

Heritability of Hand Eczema Is Not Explained by Comorbidity with Atopic Dermatitis  

Microsoft Academic Search

Genetic factors have been shown to influence the risk of hand eczema, and may theoretically influence the frequency of eruptions as well as age at onset of the disease. However, the result may be confounded by atopic dermatitis, which is a major risk factor for development of hand eczema and is known to be influenced by genetic factors. In this

Anne Lerbaek; Kirsten O Kyvik; Jakob Mortensen; Lars E Bryld; Torkil Menné; Tove Agner

2007-01-01

100

Orange-Induced Skin Lesions in Patients with Atopic Eczema: Evidence for a Non-IgE-Mediated Mechanism  

Microsoft Academic Search

Oranges are suspected of inducing adverse skin reactions in patients with atopic eczema. We studied 21 adult patients with atopic eczema and a history of adverse reactions to oranges and 10 patients without. A dietary history, skin tests, serum IgE and oral provocation tests with oranges were obtained. Severity of eczema was monitored by SCORAD, and serum tryptase, eosinophil cationic

KNUT BROCKOW; CHRISTIAN HAUTMANN; KAY FOTISCH; J URGEN RAKOSKI; SIEGFRIED BORELLI; STEFAN VIETHS; JOHANNES RING

101

Influence of Pimecrolimus Cream 1% on Different Morphological Signs of Eczema in Infants with Atopic Dermatitis  

Microsoft Academic Search

Background: In the published studies on the efficacy of the topical immunomodulator pimecrolimus, different eczema scores were used, and the impact on morphological key signs of eczema was not analysed. Objective: To compare the influence of pimecrolimus cream 1% on different standard eczema scores in infants with atopic dermatitis and to analyse the impact of treatment on the individual morphological

Kristine Breuer; Matthias Braeutigam; Alexander Kapp; Thomas Werfel

2004-01-01

102

Use of bleach baths for the treatment of infected atopic eczema.  

PubMed

Atopic eczema is one of the most common skin disorders in young children and also affects adults. Staphylococcus aureus infection is the most frequent complication of atopic eczema and is involved in the worsening of the disease. Antibiotic therapy against S.?aureus has been an important component of treatment for atopic eczema but there are concerns about antibiotic overuse and increasing bacterial resistance. This has led some clinicians to recommend the use of homemade remedies such as bleach baths as an adjunctive treatment for patients with infected atopic eczema, despite the fact that there have been few published studies in this area. Balancing safety concerns with efficacious treatment is of particular importance in the paediatric population. This review discusses the historical use of bleach in medicine as well as its recent use for atopic eczema. Further, the chemistry and safety of bleach as well as alternative therapies are examined. PMID:23330843

Barnes, Tanya M; Greive, Kerryn A

2013-11-01

103

Mapping randomized controlled trials of treatments for eczema - The GREAT database (The Global Resource of Eczema Trials: a collection of key data on randomized controlled trials of treatments for eczema from 2000 to 2010)  

PubMed Central

Background Massive duplication of effort occurs when researchers all over the world undertake extensive searches for randomized controlled trials when preparing systematic reviews, when developing evidence-based guidelines and when applying for research funding for eczema treatments. Such duplication wastes valuable resources. Searching for randomized controlled trials of eczema is a laborious task involving scrutiny of thousands of individual references from diverse electronic databases in order to obtain a few papers of interest. Clinicians and patients who wish to find out more about a particular treatment are at risk of missing the relevant evidence if they are not trained in electronic bibliographic searching. Systematic reviews cannot be relied upon to comprehensively inform current optimal eczema treatments due to incomplete coverage and because many may be out of date. An international, publically available and comprehensive resource which brings together all randomized controlled trials on eczema treatment using a highly sensitive search has the potential to release more filtered knowledge about patient care to those who need it most and to significantly shorten the duration and costs of many clinical eczema research and guideline projects. Description The Global Resource of EczemA Trials brings together information on all randomized controlled trials of eczema treatments published from the beginning of 2000 up to the end of 2010 and will be updated every month. We searched the Cochrane Central Register of Controlled Trials in The Cochrane Library and the Cochrane Skin Group Specialised Register, MEDLINE, EMBASE, LILACS, AMED and CINHAL databases. We included 268 RCTs (24th March 2011) covering over 70 different treatment interventions. The structure of the Global Resource of Eczema Trials allows the user as much, or as little, specificity when retrieving information on trials as they wish, in an easy to use format. For each trial, the database gives the citation for the published report and also provides enough information to enable a user to decide whether the trial is worth further scrutiny. Conclusions The Global Resource of Eczema Trials has been created to facilitate knowledge mobilization into healthcare and to reduce wastage of research time through unnecessary duplication. The collective time saved by research groups around the world can now be used to make strides in optimising the treatment of eczema, in order to further benefit people with eczema. The database can be accessed free of charge at http://www.greatdatabase.org.uk

2011-01-01

104

Anaphylactic shock during elimination diets for severe atopic eczema.  

PubMed Central

Eighty patients with atopic eczema were treated with various elimination diets. Some or all foods were withdrawn then later reintroduced singly to the diet. In four patients reintroduction of a single food (soya, chicken, corn, cows' milk) caused anaphylactic shock. In two patients spontaneous recovery occurred but in two resuscitation and intensive care were required. Anaphylaxis is a definite hazard of these elimination diets. Other than warning the parents, practical precautions are difficult because of the unpredictability of violent reactions and uncertainty about the life saving efficacy of injected adrenaline.

David, T J

1984-01-01

105

Trends in the epidemiology and prescribing of medication for eczema in England  

PubMed Central

Summary Background The prevalence of eczema, particularly in younger children, increased substantially over the second half of the 20th century. Analysis of primary healthcare data-sets offers the possibility to advance understanding about the changing epidemiology of eczema. Aim To investigate recent trends in the recorded incidence, lifetime prevalence, prescribing and consulting behaviour of patients with eczema in England. Methods QRESEARCH is one of the world’s largest national aggregated health databases containing the records of over nine million patients. We extracted data on all patients with a recorded diagnosis of eczema and calculated annual age–sex standardized incidence and lifetime period prevalence rates for each year from 2001–2005. We also analysed the consulting behaviour of these patients when compared with the rest of the QRESEARCH database population. The number of eczema prescriptions issued to people in England was also estimated. Results The age–sex standardized incidence of eczema was 9.58 per 1000 person-years in 2001 and increased to 13.58 per 1000 patients in 2005 (p<0.001). By 2005, eczema affected an estimated 5,773,700 (95% confidence intervals [CI] 5,754,100–5,793,400) individuals in England, who, on average, consulted a general practitioner 4.02 (95% CI 4.01–4.03) times a year. During the study period, the number of eczema related prescriptions increased by 56.6% (95% CI 56.6–56.7), so by 2005 an estimated 13,690,300 (95% CI 13,643,200–13,737,600) prescriptions were issued. Conclusions Recorded incidence and lifetime prevalence of eczema in England continue to increase. Similar increases have also been observed in the estimated number of eczema prescriptions issued to the English population.

Simpson, Colin R; Newton, John; Hippisley-Cox, Julia; Sheikh, Aziz

2009-01-01

106

MRSA infections: from classical treatment to suicide drugs.  

PubMed

Infections caused by the methicillin-resistant Staphylococcus aureus (MRSA) are today a major burden in nosocomial disease control. The global trend shows an alarming increase of MRSA infections as well as multi-drug resistance (MDR). The problem is exacerbated by the fact that infections with community-associated (CA) MRSA strains showing increased virulence and fitness add to infections with multi-drug resistant hospital-associated (HA) MRSA. The toxicity of pathogens and limited effectiveness of available treatment have led to high mortality rates and vast expenses caused by prolonged hospitalization and usage of additional antibiotics. Recently approved drugs still have classical targets and upcoming resistance can be expected. In a new approach by targeting co-factor syntheses of bacteria, the drug target and the affected pathways are uncoupled. This novel strategy is based on the thought of a classical pro-drug which has to be metabolized before becoming toxic for the bacterium as a dysfunctional co-factor, named suicide drug. Ideally these metabolizing pathways are solely present in the bacterium and absent in the human host, such as vitamin biosyntheses. This mini-review discusses current ways of MRSA infection treatment using new approaches including suicide drugs targeting co-factor biosyntheses. PMID:24251575

Drebes, Julia; Kunz, Madeleine; Pereira, Claudio A; Betzel, Christian; Wrenger, Carsten

2014-01-01

107

Warm, humid, and high sun exposure climates are associated with poorly controlled eczema: PEER (Pediatric Eczema Elective Registry) cohort, 2004-2012.  

PubMed

Anecdotal reports of children experiencing eczema flares during winter and summer months along with global variation in eczema prevalence has fueled speculation that climate may modulate disease activity. The aim of this study was to determine whether long-term weather patterns affect the severity and persistence of eczema symptoms in children. We performed a prospective cohort study of US children (N=5,595) enrolled in PEER (Pediatric Eczema Elective Registry) between 2004 and 2012 to evaluate the effect of climate (daily temperature, daily sun exposure, daily humidity) on the severity of eczema symptoms. Odds ratios (ORs) were calculated for the patient-evaluated outcome of disease control. Multivariate logistic regression modeling adjusting for gender, race, income, and topical medication use demonstrated that higher temperature (OR=0.90, 95% confidence interval (CI): 0.87-0.93, P<0.001) and increased sun exposure (OR=0.93, 95% CI: 0.89-0.98, P=0.009) were associated with poorly controlled eczema. Higher humidity (OR=0.90, 95% CI: 0.812-0.997, P=0.04) was also associated with poorly controlled disease, but the statistical significance of this association was lost in our multivariate analysis (P=0.44). PMID:23774527

Sargen, Michael R; Hoffstad, Ole; Margolis, David J

2014-01-01

108

Warm, Humid, and High Sun Exposure Climates are Associated with Poorly Controlled Eczema: PEER (Pediatric Eczema Elective Registry) Cohort, 2004-2012  

PubMed Central

Anecdotal reports of children experiencing eczema flares during winter and summer months along with global variation in eczema prevalence has fueled speculation that climate may modulate disease activity. The aim of this study was to determine if long-term weather patterns affect the severity and persistence of eczema symptoms in children. We performed a prospective cohort study of U.S. children (N=5,595) enrolled in PEER (Pediatric Eczema Elective Registry) between 2004 and 2012 to evaluate the effect of climate (daily temperature, daily sun exposure, daily humidity) on the severity of eczema symptoms. Odds ratios were calculated for the patient evaluated outcome of disease control. Multivariate logistic regression modeling adjusting for gender, race, income, and topical medication use demonstrated that higher temperature (OR=0·90, 95% CI: 0·87–0·93, p<0·001) and increased sun exposure (OR=0·93, 95% CI: 0·89–0·98, p=0·009) were associated with poorly controlled eczema. Higher humidity (OR=0·90, 95% CI: 0·812–0.997, p=0·04) was also associated with poorly controlled disease, but the statistical significance of this association was lost in our multivariate analysis (p=0.44).

Sargen, Michael R.; Hoffstad, Ole; Margolis, David J.

2013-01-01

109

Contamination of Public Buses with MRSA in Lisbon, Portugal: A Possible Transmission Route of Major MRSA Clones within the Community  

PubMed Central

In a previous study we have shown that public buses in Oporto, the second largest city in Portugal, were highly contaminated with MRSA. Here we describe the results of a similar study performed in another urban area of Portugal–Lisbon, the capital. Between May 2011 and May 2012, hand touched surfaces of 199 public buses in Lisbon were screened for MRSA contamination. Subsequently, the hands of 575 passengers who frequently use these bus lines were also screened. All hand carriers of MRSA were further screened for nasal carriage. The isolates were characterized by PFGE, staphylococcal cassette chromosome (SCC) mec typing, spa typing, MLST and were tested for the presence of mecA, Panton-Valentine leukocidin and arginine catabolic mobile element genes. MRSA contamination was shown in 72 buses (36.2%). The majority of the isolates belonged to three major clones: Clone A was identified as EMRSA-15 defined by pattern PFGE A, spa types t2357/t747/t025/t379/t910, ST22, and SCCmec IVh (n?=?21; 29%). Clone B was the New York/Japan clone characterized by PFGE B-t002/t10682-ST5-II (n?=?15; 21%). Clone C included isolates with characteristics of the international community-acquired USA300 or related clones, PFGE C-t008-ST8-IVa/IVc/IVg/IVnt/VI (n?=?19; 26%). The first two clones are currently the two major lineages circulating in Portuguese hospitals. The hands of 15 individuals were contaminated with MRSA belonging to the nosocomial clones A or B. Eleven of these individuals were not nasal carriers of MRSA and all but one had travelled by public transportation, namely by bus, prior to sampling. In conclusion, public buses in two major cities in Portugal are often contaminated with MRSA representing clones dominant in hospitals in the particular geographic area. MRSA contamination of public transport and the transfer of the bacteria to the hands of passengers may represent a route through which hospital-acquired MRSA clones may spread to the community.

Conceicao, Teresa; Diamantino, Fernanda; Coelho, Celine; de Lencastre, Herminia; Aires-de-Sousa, Marta

2013-01-01

110

Contamination of public buses with MRSA in Lisbon, Portugal: a possible transmission route of major MRSA clones within the community.  

PubMed

In a previous study we have shown that public buses in Oporto, the second largest city in Portugal, were highly contaminated with MRSA. Here we describe the results of a similar study performed in another urban area of Portugal-Lisbon, the capital. Between May 2011 and May 2012, hand touched surfaces of 199 public buses in Lisbon were screened for MRSA contamination. Subsequently, the hands of 575 passengers who frequently use these bus lines were also screened. All hand carriers of MRSA were further screened for nasal carriage. The isolates were characterized by PFGE, staphylococcal cassette chromosome (SCC) mec typing, spa typing, MLST and were tested for the presence of mecA, Panton-Valentine leukocidin and arginine catabolic mobile element genes. MRSA contamination was shown in 72 buses (36.2%). The majority of the isolates belonged to three major clones: Clone A was identified as EMRSA-15 defined by pattern PFGE A, spa types t2357/t747/t025/t379/t910, ST22, and SCCmec IVh (n = 21; 29%). Clone B was the New York/Japan clone characterized by PFGE B-t002/t10682-ST5-II (n = 15; 21%). Clone C included isolates with characteristics of the international community-acquired USA300 or related clones, PFGE C-t008-ST8-IVa/IVc/IVg/IVnt/VI (n = 19; 26%). The first two clones are currently the two major lineages circulating in Portuguese hospitals. The hands of 15 individuals were contaminated with MRSA belonging to the nosocomial clones A or B. Eleven of these individuals were not nasal carriers of MRSA and all but one had travelled by public transportation, namely by bus, prior to sampling. In conclusion, public buses in two major cities in Portugal are often contaminated with MRSA representing clones dominant in hospitals in the particular geographic area. MRSA contamination of public transport and the transfer of the bacteria to the hands of passengers may represent a route through which hospital-acquired MRSA clones may spread to the community. PMID:24223124

Conceição, Teresa; Diamantino, Fernanda; Coelho, Céline; de Lencastre, Hermínia; Aires-de-Sousa, Marta

2013-01-01

111

Methicillin resistant Staphylococcus aureus (MRSA) in India: Prevalence & susceptibility pattern  

PubMed Central

Background & objectives: Methicillin resistant Staphylococcus aureus (MRSA) is endemic in India and is a dangerous pathogen for hospital acquired infections. This study was conducted in 15 Indian tertiary care centres during a two year period from January 2008 to December 2009 to determine the prevalence of MRSA and susceptibility pattern of S. aureus isolates in India. Methods: All S. aureus isolates obtained during the study period in the participating centres were included in the study. Each centre compiled their data in a predefined template which included data of the antimicrobial susceptibility pattern, location of the patient and specimen type. The data in the submitted templates were collated and analysed. Results: A total of 26310 isolates were included in the study. The overall prevalence of methicillin resistance during the study period was 41 per cent. Isolation rates for MRSA from outpatients, ward inpatients and ICU were 28, 42 and 43 per cent, respectively in 2008 and 27, 49 and 47 per cent, respectively in 2009. The majority of S. aureus isolates was obtained from patients with skin and soft tissue infections followed by those suffering from blood stream infections and respiratory infections. Susceptibility to ciprofloxacin was low in both MSSA (53%) and MRSA (21%). MSSA isolates showed a higher susceptibility to gentamicin, co-trimoxazole, erythromycin and clindamycin as compared to MRSA isolates. No isolate was found resistant to vancomycin or linezolid. Interpretation & conclusions: The study showed a high level of MRSA in our country. There is a need to study epidemiology of such infections. Robust antimicrobial stewardship and strengthened infection control measures are required to prevent spread and reduce emergence of resistance.

Joshi, Sangeeta; Ray, Pallab; Manchanda, Vikas; Bajaj, Jyoti; Chitnis, D.S.; Gautam, Vikas; Goswami, Parijath; Gupta, Varsha; Harish, B.N.; Kagal, Anju; Kapil, Arti; Rao, Ratna; Rodrigues, Camilla; Sardana, Raman; Devi, Kh Sulochana; Sharma, Anita; Balaji, Veeragaghavan

2013-01-01

112

Immunomodulatory effects of recombinant lactoferrin during MRSA infection.  

PubMed

Methicillin-resistant Staphylococcus aureus (MRSA) infection remains a serious hazard to global health. The use of immune modulatory therapy to combat infection is gaining an interest as a novel treatment alternative. Lactoferrin (LF), an iron binding protein with immune modulating properties, has the potential to modify the course of systemic MRSA infection. Specifically, LF is capable of limiting deleterious inflammatory responses while promoting the development of antigen specific T-cell activity. The efficacy of a novel recombinant mouse LF (rmLF) to protect against MRSA infection was examined in a mouse peritonitis model. BALB/c mice were infected with a lethal dose of MRSA and treated at 2h post-infection with rmLF. Effects of rmLF on MRSA-infected primary monocytes and granulocytes were analyzed for inflammatory mediators. The rmLF treated mice demonstrated a modest increase in survival of more than 24h, albeit with reduced bacteremia. Serum cytokines, IL-17 and IL-6, were significantly reduced post-challenge post-rmLF treatment. The rmLF led to a minor decrease in IL-1b, and a slight increase in TNF-a production. Preliminary investigation towards human clinical relevance was accomplished using human blood derived monocytes and granulocytes infected with MRSA and treated with homologous recombinant human LF (rhLF). Treatment with (rhLF) led to increased production of IFN-g and IL-2. The human cell studies also showed a concurrent decrease in TNF-a, IL-6, IL-1b, IL-12p40, and IL-10. These results indicate that the rmLF and rhLF have a high degree of overlap to modify inflammatory responses, although differences in activities were observed between the two heterologous recombinant molecules. PMID:24613206

Hwang, Shen-An; Kruzel, Marian L; Actor, Jeffrey K

2014-05-01

113

The Emergence and Importation of Diverse Genotypes of Methicillin-Resistant Staphylococcus aureus (MRSA) Harboring the Panton-Valentine Leukocidin Gene (pvl) Reveal that pvl Is a Poor Marker for Community-Acquired MRSA Strains in Ireland  

Microsoft Academic Search

Community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) carrying pvl is an emerging problem worldwide. CA-MRSA tends to harbor staphylococcal cassette chromosome mec type IV (SCCmec IV), to be non-multiantibiotic resistant, and to have different genotypes from the local hospital-acquired MRSA (HA-MRSA). However, in Ireland, 80% of HA-MRSA isolates have the non-multiantibiotic-resistant genotype ST22-MRSA-IV. This study investigated MRSA isolates from Ireland (CA-MRSA, health

Angela S. Rossney; Anna C. Shore; Pamela M. Morgan; Margaret M. Fitzgibbon; Brian O'Connell; David C. Coleman

2007-01-01

114

Suicidal ideation, mental health problems, and social function in adolescents with eczema: a population-based study.  

PubMed

There are few studies on psychosocial problems in adolescents with eczema. We performed a cross-sectional, questionnaire-based study to explore the relationship of suicidal ideation, mental health problems, and social functioning with eczema. A total of 4,744 adolescents (18-19 years) were invited for the study, of whom 3,775 (80%) participated. The overall prevalence of current eczema was 9.7%. Among those with current eczema, 15.5% reported suicidal ideation compared with 9.1% among those without eczema, significantly associated in a multivariate model (odds ratio 1.87, 95% confidence interval 1.31-2.68). In a subgroup analyses, the prevalence of suicidal ideation in those with both eczema and itch was 23.8%, and was significantly associated, compared with those without eczema (3.57, 2.46-5.67). Eczema was associated with mental health problems assessed by the Strength and Difficulties Questionnaire (1.72, 1.21-2.45) and the Hopkins Symptom Checklist 10 (1.63, 1.23-2.16). Five questions assessed social function: feeling attached to family and friends; thriving at school; experiencing bullying; and romantic relationships. Boys with current eczema were less likely to have had romantic relationships (1.93, 1.21-3.08). Eczema in late adolescence is associated with suicidal ideation and mental health problems but rarely with social problems. Our findings point to the importance of addressing mental health issues in adolescents with eczema. PMID:24496238

Halvorsen, Jon A; Lien, Lars; Dalgard, Florence; Bjertness, Espen; Stern, Robert S

2014-07-01

115

The Quality of Life and Depressive Mood among Korean Patients with Hand Eczema  

PubMed Central

Background Hand eczema is a disease frequently observed in dermatological practice. This condition has negative emotional, social, and psychological effects due to its impact on daily life and morphological appearance. Due to its considerable effect on the quality of life, this disease can lead to depression. However, not many studies have been performed on the quality of life and depression in hand eczema patients. Objective The purpose of this study is to investigate the association between the quality of life, depression, and disease severity in hand eczema patients in South Korea. Methods A total of 138 patients with hand eczema participated in this study. The patients' quality of life was assessed by a self-administered questionnaire using the Dermatology Life Quality Index (DLQI). Data on patients suffering from depression was obtained using the Beck's Depression Inventory (BDI-II). The disease severity was determined during the clinical examination, according to the Hand Eczema Severity Index (HECSI). Results We found positive associations between DLQI and HECSI scores (p<0.05). BDI-II scores had also statistically positive correlations with HECSI scores (p<0.05). DLQI and BDI-II scores both increased with disease severity. Conclusion Hand eczema negatively affected the quality of life and mood of patients relative to the disease severity. Therefore, we suggest that quality of life modification and emotional support should be included as a part of treatment for hand eczema.

Yu, Mi; Lee, June Hyunkyung; Son, Sook-Ja

2012-01-01

116

Time trends, ethnicity and risk factors for eczema in New Zealand children: ISAAC Phase Three  

PubMed Central

Background Eczema is a common chronic disease which has significant morbidity and costs for children and their families. Phase One (1993) of the International Study of Asthma and Allergies in Childhood (ISAAC) found a high prevalence of symptoms of eczema in New Zealand. Objective In Phase Three (2001-3) we aimed to answer these three questions: Is the prevalence of eczema changing over time?; Are there ethnic differences in prevalence?; and What are the risk factors for eczema? Methods Five New Zealand centres participated in ISAAC Phases One and Three using the same methodology. Questionnaires about ethnicity, symptoms of eczema and environmental factors were completed by parents of 6-7 year olds (children) and self-completed by 13-14 year olds (adolescents). Prevalence and change per year were calculated by centre, ethnicity and gender. Prevalence differences between centres and associations with environmental factors were examined using logistic regression. Results There was little change in prevalence over time for the children, and a decrease in prevalence for the adolescents. Prevalence was higher among M?ori and even higher among Pacific participants than among European children. Positive associations with current eczema symptoms were found for both age groups for truck traffic in the street of residence, and current paracetamol consumption, and for children only, antibiotics or paracetamol in the 1st year of life. Inverse associations were found with residence in New Zealand less than 5 years, consumption of milk, seafood, and eggs, and presence of a dog in the home. Conclusion Eczema remains a significant problem, particularly for young M?ori and Pacific New Zealanders in whom less recognition of eczema and poorer access to effective, sustained eczema management may be contributing factors. Reverse causation may explain all the environmental findings apart from truck traffic which is increasing in New Zealand.

Clayton, Tadd; Crane, Julian; Ellwood, Philippa; Mackay, Richard; Mitchell, Edwin A; Moyes, Chris D; Pattemore, Philip; Pearce, Neil; Stewart, Alistair W

2013-01-01

117

Genetic and Environmental Risk Factors for Childhood Eczema Development and Allergic Sensitization in the CCAAPS Cohort  

PubMed Central

Eczema is very common and increasing in prevalence. Prospective studies investigating environmental and genetic risk factors for eczema in a birth cohort are lacking. We evaluated risk factors that may promote development of childhood eczema in the Cincinnati Childhood Allergy and Air Pollution Study (CCAAPS) birth cohort (n = 762) of infants with at least one atopic parent. Objective environmental exposure data were available for each participant. At annual physical examinations, children underwent skin prick tests (SPTs), eczema was diagnosed by a clinician, and DNA was collected. Among Caucasian children, 39% developed eczema by age 3. Children with a pet dog were significantly less likely to have eczema at age one (odds ratio (OR) 0.62, 95% confidence interval (CI): 0.40–0.97) or at both ages 2 and 3 (OR = 0.54, 95% CI: 0.30–0.97). This finding was most significant among children carrying the CD14–159C/T CC genotype. Carriers of the CD14–159C/T and IL4R? I75V single-nucleotide polymorphisms (SNPs) had an increased risk of eczema at ages 2 and 3 (OR 3.44, 95% CI: 1.56–7.57), especially among children who were SPT+. These results provide new insights into the pathogenesis of eczema in high-risk children and support a protective role for early exposure to dog, especially among those carrying the CD14–159C/T SNP. The results also demonstrate a susceptible effect of the combination of CD14 and IL4R? SNPs with eczema.

Myers, Jocelyn M. Biagini; Wang, Ning; LeMasters, Grace; Bernstein, David I.; Epstein, Tolly; Lindsey, Mark; Ericksen, Mark; Chakraborty, Ranajit; Ryan, Patrick; Villareal, Manuel; Burkle, Jeff; Lockey, James; Reponen, Tiina; Hershey, Gurjit K. Khurana

2009-01-01

118

Does smoking influence the efficacy of bath-PUVA therapy in chronic palmoplantar eczema?  

PubMed

Bath-PUVA therapy has been described as successful treatment for palmoplantar eczema. However, our own observations showed that patients with palmoplantar eczema of the dyshidrotic or hyperkeratotic type responded only partially to bath-PUVA therapy. In order to evaluate environmental influences possibly having an impact on the efficacy of this therapy, smokers and non-smokers suffering from palmoplantar eczema treated with bath-PUVA therapy were compared. A retrospective study was conducted involving 62 patients, 39 non-smokers and 23 smokers, with palmar and/or plantar eczema resistant to local corticosteroids. Bath-PUVA therapy was performed according to the European standard regimen for oral PUVA therapy. The total number of treatments and the cumulative UVA-dose were similar in smokers and non-smokers (smokers 24+/-17.7 (mean+/-SD) and 67.6+/-51.3 J/cm2 vs. non-smokers 25.7+/-16.3 and 68.5+/-49.3 J/cm2). In the group of non-smokers, 31% showed complete remission (CR; 100% clearance), 33% partial remission (PR; more than 50% clearance) and 36% no change after treatment (NC; less than 50% clearance). In contrast, the group of smokers showed only 13% CR and 22% PR, whereas 65% exhibited NC. The differences regarding complete or partial remission between the groups were statistically significant (Student t-test for paired samples; P<0.05). Regarding the different type of eczema, bath-PUVA proved to be more successful in the dyshidrotic type of eczema as compared to the hyperkeratotic type in non-smokers (P<0.05). In the group of smokers no CR was achieved in patients suffering from the dyshidrotic form of eczema. Smoking is likely to be a reason for the failure of bath-PUVA therapy in the treatment of chronic palmoplantar eczema, in particular regarding smokers with eczema of the dyshidrotic type where no complete remission was achieved. PMID:10721861

Douwes, K E; Karrer, S; Abels, C; Landthaler, M; Szeimies, R M

2000-02-01

119

Active Surveillance of the Trachea or Throat for MRSA Is More Sensitive than Nasal Surveillance and a Better Predictor of MRSA Infections among Patients in Intensive Care  

PubMed Central

Background Methicillin-resistant Staphylococcus aureus (MRSA) is one of the most common causes of infection in the intensive care unit (ICU). Although surveillance culture for MRSA is recommended for ICU patients, no comparative study investigating the optimal sites and frequency of culture has been performed in this population. Methods A prospective observational cohort study was performed in an 18-bed emergency intensive care unit (EICU) in a tertiary teaching hospital. A total of 282 patients were included. Samples for MRSA detection were obtained at the time of admission, 48 h after admission, and then weekly thereafter. All subjects were routinely monitored for the development of MRSA infection during their stay in the ICU. Results MRSA colonization was detected in 129 (46%) patients over the course of the study. The sensitivity of MRSA surveillance culture was significantly higher in throat or tracheal aspirates (82%; 106/129) than in anterior nares (47%; 61/129) (P<0.001). The sensitivity of MRSA surveillance culture for subsequent MRSA infection and MRSA pneumonia was also higher in the throat/trachea (69 and 93%, respectively) than in the anterior nares (48 and 50%, respectively). The area under the curve for subsequent MRSA infection was higher in trachea/throat (0.675) than in the anterior nares (0.648); however, this difference was not significant (P>0.05). The area under the curve for MRSA pneumonia was significantly higher in trachea/throat (0.791; 95% CI, 0.739-0.837) than anterior nares (0.649; 95% CI, 0.590-0.705) (P?=?0.044). Conclusion MRSA colonization was more common in the trachea/throat than in the anterior nares in ICU patients. Cultures from throat or tracheal aspirates were more sensitive and predictive of subsequent MRSA pneumonia than cultures from the anterior nares in this population.

Kim, Gwang-Sook; Jang, Mi-Ok; Kang, Seung-Ji; Jung, Sook-In; Shin, Jong-Hee; Chun, Byeong Jo; Park, Kyung-Hwa

2014-01-01

120

Validity of ICD-9-CM Coding for Identifying Incident Methicillin-Resistant Staphylococcus aureus (MRSA) Infections: Is MRSA Infection Coded as a Chronic Disease?  

PubMed Central

BACKGROUND AND OBJECTIVE Investigators and medical decision makers frequently rely on administrative databases to assess methicillin-resistant Staphylococcus aureus (MRSA) infection rates and outcomes. The validity of this approach remains unclear. We sought to assess the validity of the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) code for infection with drug-resistant microorganisms (V09) for identifying culture-proven MRSA infection. DESIGN Retrospective cohort study. METHODS All adults admitted to 3 geographically distinct hospitals between January 1, 2001, and December 31, 2007, were assessed for presence of incident MRSA infection, defined as an MRSA-positive clinical culture obtained during the index hospitalization, and presence of the V09 ICD-9-CM code. The k statistic was calculated to measure the agreement between presence of MRSA infection and assignment of the V09 code. Sensitivities, specificities, positive predictive values, and negative predictive values were calculated. RESULTS There were 466,819 patients discharged during the study period. Of the 4,506 discharged patients (1.0%) who had the V09 code assigned, 31% had an incident MRSA infection, 20% had prior history of MRSA colonization or infection but did not have an incident MRSA infection, and 49% had no record of MRSA infection during the index hospitalization or the previous hospitalization. The V09 code identified MRSA infection with a sensitivity of 24% (range, 21%–34%) and positive predictive value of 31% (range, 22%–53%). The agreement between assignment of the V09 code and presence of MRSA infection had a ? coefficient of 0.26 (95% confidence interval, 0.25–0.27). CONCLUSIONS In its current state, the ICD-9-CM code V09 is not an accurate predictor of MRSA infection and should not be used to measure rates of MRSA infection.

Schweizer, Marin L.; Eber, Michael R.; Laxminarayan, Ramanan; Furuno, Jon P.; Popovich, Kyle J.; Hota, Bala; Rubin, Michael A.; Perencevich, Eli N.

2013-01-01

121

Public engagement with emerging infectious disease: The case of MRSA in Britain  

Microsoft Academic Search

As a route to providing a framework for elucidating the content of public thinking concerning emerging and re-emerging infectious diseases (EID), this article examines public engagement with methicillin-resistant Staphylococcus aureus (MRSA). It explores how British lay publics represent MRSA utilising a social representations framework. For this group, MRSA is associated primarily with dirty National Health Service (NHS) hospitals that have

Hélène Joffe; Peter Washer; Christian Solberg

2011-01-01

122

Antibacterial resistance and their genetic location in MRSA isolated in Kuwait hospitals, 1994-2004  

Microsoft Academic Search

BACKGROUND: Methicillin-resistant Staphylococcus aureus (MRSA) continues to be a major cause of serious infections in hospitals and in the community worldwide. In this study, MRSA isolated from patients in Kuwait hospitals were analyzed for resistance trends and the genetic location of their resistance determinants. METHODS: Between April 1994 and December 2004, 5644 MRSA isolates obtained from different clinical samples were

Edet E Udo; Noura Al-Sweih; Eiman Mokaddas; Molly Johny; Rita Dhar; Huda H Gomaa; Inaam Al-Obaid; Vincent O Rotimi

2006-01-01

123

Patients with Methicillin-Resistant Staphylococcus aureus (MRSA) Infection - 21st Century Lepers  

PubMed Central

In the recent past, there has been a dramatic increase in the incidence of methicillin-resistant Staphylococcus aureus (MRSA) infections, especially community-associated methicillin-resistant S. aureus (CA-MRSA) infections. Many media descriptions of MRSA are sensational and focus on its potential for severe disease and contagiousness. Our objective is to describe psychological and social morbidity associated with MRSA infection via a case series of five patients with CA-MRSA infection. We also analyze the resulting stigmatization associated with being diagnosed with MRSA infection. We learned that patients describe a variety of stigmatization related to their diagnosis of MRSA, including being shunned at home and in the workplace. Patients describe being asked by family, colleagues, and clients to take extraordinary measures to prevent MRSA transmission. Consequences of MRSA diagnoses have included erosion or termination of key personal and business relationships. In conclusion, stigmatization resulting from the diagnosis of MRSA can have profound personal and social morbidity. Media and public health awareness of MRSA infection needs to be balanced with information about how MRSA transmission is usually preventable with simple hygienic measures.

Mozzillo, Kristin L.; Ortiz, Nancy; Miller, Loren G.

2009-01-01

124

Combating CA-MRSA in Physical Education, Sports, and Dance  

ERIC Educational Resources Information Center

By now most people have heard about the deadly bacteria that can fester in locker rooms, on sports equipment, and in dance facilities, among other places. This article was written to help PERD professionals become better informed about these bacteria, called community-acquired methicillin-resistant "Staphylococcus aureus" (CA-MRSA). Readers will…

Andrews, Amanda K.; Howard-Shaughnessy, Candice; Adams, Jon E.

2007-01-01

125

MRSA CC398 in the pig production chain  

Microsoft Academic Search

In 2005, a distinct clone of methicillin resistant Staphylococcus aureus (MRSA CC398) was found in pigs and people in contact with pigs. The structure of the pig production chain in high technology pig husbandry enables pathogens to spread during animal trading, with an increasing prevalence in herds further down the chain. The objective of this study was to quantify the

E. M. Broens; E. A. M. Graat; P. J. van der Wolf; A. W. van de Giessen; E. van Duijkeren; J. A. Wagenaar; A. van Nes; D. J. Mevius; M. C. M. de Jong

2011-01-01

126

Transferable vancomycin resistance in a community-associated MRSA lineage.  

PubMed

We report the case of a patient from Brazil with a bloodstream infection caused by a strain of methicillin-resistant Staphylococcus aureus (MRSA) that was susceptible to vancomycin (designated BR-VSSA) but that acquired the vanA gene cluster during antibiotic therapy and became resistant to vancomycin (designated BR-VRSA). Both strains belong to the sequence type (ST) 8 community-associated genetic lineage that carries the staphylococcal chromosomal cassette mec (SCCmec) type IVa and the S. aureus protein A gene (spa) type t292 and are phylogenetically related to MRSA lineage USA300. A conjugative plasmid of 55,706 bp (pBRZ01) carrying the vanA cluster was identified and readily transferred to other staphylococci. The pBRZ01 plasmid harbors DNA sequences that are typical of the plasmid-associated replication genes rep24 or rep21 described in community-associated MRSA strains from Australia (pWBG745). The presence and dissemination of community-associated MRSA containing vanA could become a serious public health concern. PMID:24738669

Rossi, Flávia; Diaz, Lorena; Wollam, Aye; Panesso, Diana; Zhou, Yanjiao; Rincon, Sandra; Narechania, Apurva; Xing, Galen; Di Gioia, Thais S R; Doi, André; Tran, Truc T; Reyes, Jinnethe; Munita, Jose M; Carvajal, Lina P; Hernandez-Roldan, Alejandra; Brandão, Denise; van der Heijden, Inneke Marie; Murray, Barbara E; Planet, Paul J; Weinstock, George M; Arias, Cesar A

2014-04-17

127

MRSA carriage in healthcare personnel in contact with farm animals  

Microsoft Academic Search

In The Netherlands it has been shown that people in contact with pigs have a higher risk of meticillin-resistant Staphylococcus aureus (MRSA) carriage than the general population. Isolates of closely related spa types, corresponding to multilocus sequence type (MLST) ST398, were found in pig farmers, pig veterinarians and pigs. The objective of this study was to investigate whether contact with

M. W. H. Wulf; E. Tiemersma; J. Kluytmans; D. Bogaers; A. C. A. P. Leenders; M. W. H. Jansen; J. Berkhout; E. Ruijters; D. Haverkate; M. Isken; A. Voss

2008-01-01

128

Mapping randomized controlled trials of treatments for eczema - The GREAT database (The Global Resource of Eczema Trials: a collection of key data on randomized controlled trials of treatments for eczema from 2000 to 2010)  

Microsoft Academic Search

Background  Massive duplication of effort occurs when researchers all over the world undertake extensive searches for randomized controlled\\u000a trials when preparing systematic reviews, when developing evidence-based guidelines and when applying for research funding\\u000a for eczema treatments. Such duplication wastes valuable resources.\\u000a \\u000a \\u000a Searching for randomized controlled trials of eczema is a laborious task involving scrutiny of thousands of individual references\\u000a from diverse

Helen Nankervis; Alan Maplethorpe; Hywel C Williams

2011-01-01

129

Higher incidence of perineal community acquired MRSA infections among toddlers  

PubMed Central

Background A six-fold increase in pediatric MRSA infections, prompted us to examine the clinical profile of children with MRSA infections seen at Mercy Children's Hospital, Toledo, Ohio and to characterize the responsible strains. Methods Records were reviewed of pediatric patients who cultured positive for MRSA from June 1 to December 31, 2007. Strain typing by pulsed field gel electrophoresis (PFT) and DiversiLab, SCCmec typing, and PCR-based lukSF-PV gene (encodes Panton-Valentine leukocidin), arginine catabolic mobile element (ACME) and cap5 gene detection was performed. Results Chart review of 63 patients with MRSA infections revealed that 58(92%) were community acquired MRSA (CAMRSA). All CAMRSA were skin and soft tissue infections (SSTI). Twenty five (43%) patients were aged < 3 yrs, 19(33%) aged 4-12 and 14(24%) aged 13-18. Nineteen (76%) of those aged < 3 yrs had higher incidence of perineal infections compared to only 2(11%) of the 4-12 yrs and none of the 13-18 yrs of age. Infections in the extremities were more common in the older youth compared to the youngest children. Overall, there was a significant association between site of the infection and age group (Fisher's Exact p-value < 0.001). All CAMRSA were USA300 PFT, clindamycin susceptible, SCCmec type IVa and lukSF-PV gene positive. Nearly all contained ACME and about 80% were cap5 positive. Of the 58 USA300 strains by PFT, 55(95%) were also identified as USA300 via the automated repetitive sequence-based PCR method from DiversiLab. Conclusions CAMRSA SSTI of the perineum was significantly more common among toddlers and that of the extremities in older children. The infecting strains were all USA300 PFT. Further studies are needed to identify the unique virulence and colonization characteristics of USA300 strains in these infections.

2011-01-01

130

Epidemiology of MRSA and current strategies in Europe and Japan  

PubMed Central

The prevalence of health-care associated infections caused by multi-drug resistant organisms has significantly increased over the past decade. Among these organisms, Methicillin-resistant Staphylococcus aureus (MRSA) plays a prominent and increasing role. Because of consequences for patients and the economic burden in course of prolonged treatment following MRSA infections and additional indirect costs for e.g. isolation or antiseptic treatment, this trend will further damage European health-care systems. In 2006, a workshop was initiated at the 8th International Congress of the German Society of Hospital Hygiene held in Berlin. The aim of this workshop was to give an overview of the current situation of MRSA in selected European countries and to elaborate on potential strategies to prevent MRSA-infections and dissemination. A questionnaire encompassing 20 questions addressed topics such as epidemiology, current measures and future prospects was distributed to representatives from various European countries and Japan. A variety of widely different answers was obtained. It was shown that in all countries prevalence of MRSA is on a rising tide. This trend is observable in all European countries, albeit less strong in The Netherlands, Slovenia, France, Austria and Scandinavian countries. It was conclude that prevention strategies in a united and expanding European Community will become of utmost importance and that rapid screening strategies, e.g. PCR, might be of assistance in such an approach. A potential strategy to improve infection control measures could be the requirement of health-insurance providers to sign contracts only with hospitals able to proof having an infection control management in place.

Kramer, Axel; Wagenvoort, Hans; Ahren, Christina; Daniels-Haardt, Inka; Hartemann, Philippe; Kobayashi, Hiro; Kurcz, Andrea; Picazo, Juan; Privitera, Gaetano; Assadian, Ojan

2010-01-01

131

Pathological changes in platelet histamine oxidases in atopic eczema  

PubMed Central

Increased plasma histamine levels were associated with significantly lowered diamine and type B monoamine oxidase activities in platelet-rich plasma of atopic eczema (AE) patients. The diamine oxidase has almost normal cofactor levels (pyridoxal phosphate and Cu2+) but the cofactor levels for type B monoamine oxidase (flavin adenine dinucleotide and Fe2+) are lowered. The biogenic amines putrescine, cadaverine, spermidine, spermine, tyramine and serotonin in the sera, as well as dopamine and epinephrine in EDTA-plasma were found to be normal. It is unlikely, therefore, that these amines are responsible for the decreased activities of monoamine and diamine oxidase in these patients. The most likely causative factors for the inhibition of the diamine oxidase are nicotine, alcohol, food additives and other environmental chemicals, or perhaps a genetic defect of the diamine oxidase.

Ionescu, Gruia

1993-01-01

132

Clinical biochemistry of sporidesmin natural intoxication (facial eczema) of sheep.  

PubMed

The effects of facial eczema, i.e. intoxication by the mycotoxin sporidesmin, were investigated by extensive biochemical screening of serum in 100 controls (A), 31 clinically ill (B) and 219 apparently healthy (C) Manech ewes under field conditions. Dramatic increases of gamma-glutamyltransferase1), alkaline phosphatases, bilirubin, cholesterol, aspartate and alanine aminotransferases, and lactate dehydrogenase confirmed the severity of liver damage in group B, but they were also observed in slightly more than 50% of group C animals. This demonstrated the true extent of the disease, which could be best assessed by the measurement of serum gamma-glutamyltransferase; but since this enzyme was still elevated one year later, it cannot be used as a reliable prognostic parameter. PMID:2566642

Bonnefoi, M; Braun, J P; Bézille, P; LeBars, J; Sawadogo, G; Thouvenot, J P

1989-01-01

133

Eczema in early life: Genetics, the skin barrier, and lessons learned from birth cohort studies  

PubMed Central

Eczema is a chronic inflammatory disorder of the skin that affects up to 30% of children. It often afflicts infants in the first few months of life and can be the first indicator of the atopic march. Recent results from birth cohort studies have uncovered novel information regarding genetic and environmental factors that promote the development of eczema. Birth cohort studies provide an optimal study design to elucidate these associations and prospectively track longitudinal data including exposure assessment and health outcomes from birth into early life and childhood. This is especially relevant for eczema given the age specific emergence of this disease. In this review, we will provide a general overview of pediatric eczema and discuss the important findings in the literature with respect to genetics and environmental exposures, highlighting those derived from birth cohort studies. Additionally, we will review how these relate to the atopic march, the hygiene hypothesis and the integrity of the skin barrier.

Biagini Myers, Jocelyn M.; Khurana Hershey, Gurjit K.

2010-01-01

134

Studies on treating eczema by Chinese herbal medicine with anti-type IV allergic activity  

Microsoft Academic Search

Objective: To study Chinese herbal prescription for treatment of eczema on the basis of the suppressive effect of Chinese herbal medicine\\u000a with type IV allergic reaction.Methods: Various formulae composed of Chinese herbal medicines possessing suppressive effect on murine allergic contact dermatitis\\u000a were formed following the therapeutic principles of traditional Chinese medicine in treating eczema, and their effect on ear\\u000a swelling,

Xi-ran Lin; Cai-xia Tu; Xian-min Meng; Chun-mei Yang; Ming-yang Gao; Ling Gu

2001-01-01

135

Early introduction of fish decreases the risk of eczema in infants  

PubMed Central

Background: Atopic eczema in infants has increased in western societies. Environmental factors and the introduction of food may affect the risk of eczema. Aims: To investigate the prevalence of eczema among infants in western Sweden, describe patterns of food introduction and assess risk factors for eczema at 1 year of age. Methods: Data were obtained from a prospective, longitudinal cohort study of infants born in western Sweden in 2003; 8176 families were randomly selected and, 6 months after the infant’s birth, were invited to participate and received questionnaires. A second questionnaire was sent out when the infants were 12 months old. Both questionnaires were completed and medical birth register data were obtained for 4921 infants (60.2% of the selected population). Results: At 1 year of age, 20.9% of the infants had previous or current eczema. Median age at onset was 4 months. In multivariable analysis, familial occurrence of eczema, especially in siblings (OR 1.87; 95% confidence interval (CI) 1.50 to 2.33) or the mother (OR 1.54; 95% CI 1.30 to 1.84), remained an independent risk factor. Introducing fish before 9 months of age (OR 0.76; 95% CI 0.62 to 0.94) and having a bird in the home (OR 0.35; 95% CI 0.17 to 0.75) were beneficial. Conclusions: One in five infants suffer from eczema during the first year of life. Familial eczema increased the risk, while early fish introduction and bird keeping decreased it. Breast feeding and time of milk and egg introduction did not affect the risk.

Alm, B; Aberg, N; Erdes, L; Mollborg, P; Pettersson, R; Norvenius, S G; Goksor, E; Wennergren, G

2009-01-01

136

Risk for hand eczema in employees with past or present atopic dermatitis  

Microsoft Academic Search

Persons with atopic dermatitis run a considerable risk of developing hand eczema when exposed to occupational agents that\\u000a are a burden to the skin. This also pertains to those with a history of skin atopy in childhood. This review presents estimates\\u000a of the risk of developing hand eczema and examines the evidence for an effect modification by skin atopy on

Pieter-Jan Coenraads; Thomas L. Diepgen

1998-01-01

137

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

PubMed Central

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.

Monecke, Stefan; Muller, Elke; Dorneanu, Olivia Simona; Vremera, Teodora; Ehricht, Ralf

2014-01-01

138

Staphylococcus aureus: Screening for Nasal Carriers in a Community Setting with Special Reference to MRSA  

PubMed Central

Introduction. Emergence of MRSA infections among previously healthy persons in community settings (without exposure to health care facilities) has been noted recently. MRSA infections are now classified as health care-associated MRSA (HA-MRSA) and community-associated MRSA (CA-MRSA) infections. Its colonization is an important risk factor for subsequent MRSA infection. Aims and Objectives. The aim was to screen patients and health care workers for staphylococcal carriage, identify risk factors for MRSA colonization, and determine the sensitivity pattern. Materials and Methods. A total of 200 subjects were screened for nasal carriage after obtaining verbal consent. These were both healthy subjects attending various outpatient departments and health care workers. Specimens were collected from the anterior nares using premoistened sterile cotton swabs and inoculated onto blood agar and mannitol salt agar and incubated at 37°C for 24–48?h. Results. Staphylococcus aureus colonisation was found to be 12% (n = 24). MRSA was identified in 5% (n = 10) which represents 41.66% of SA. A total of 10 strains of MRSA were isolated from 200 subjects, giving an overall positivity rate of 5%. Discussion. Staphylococcal colonization was found to be 12% (MRSA 5%). Fluoroquinolone resistance was remarkable whereas all strains were sensitive to vancomycin, teicoplanin, linezolid, quinupristin-dalfopristin.

Sharma, Yukti; Jain, Sanjay; Singh, Harshvardhan; Govil, Vasudha

2014-01-01

139

Transcriptional analysis of antibiotic resistance and virulence genes in multiresistant hospital-acquired MRSA.  

PubMed

The staphylococcal chromosome cassette mec cannot solely explain the multiresistance phenotype or the relatively mild virulence profile of hospital-acquired methicillin-resistant Staphylococcus aureus (HA-MRSA). This study reports that several multiresistant HA-MRSA strains differently expressed genes that may support antibiotic resistance, modify the bacterial surface and influence the pathogenic process. Genes encoding efflux pumps (norA, arsB, emrB) and the macrolide resistance gene ermA were found to be commonly expressed by HA-MRSA strains, but not in the archetypal MRSA strain COL. At equivalent cell density, the agr system was considerably less activated in all MRSA strains (including COL) in comparison with a prototypic antibiotic-susceptible strain. These results are in contrast to those observed in recent community-acquired MRSA isolates and may partly explain how multiresistant HA-MRSA persist in the hospital setting. PMID:21668513

Pruneau, Mireille; Mitchell, Gabriel; Moisan, Hélène; Dumont-Blanchette, Emilie; Jacob, Christian L; Malouin, François

2011-10-01

140

Quality of life in patients with hand eczema as health promotion: a case control study.  

PubMed

Health promotion has been defined by the World Health Organization's (WHO) 2005 Bangkok Charter for Health Promotion as "the process of enabling people to increase control over their health and its determinants, and thereby improve their health". One of the most important determinants of health is quality of life. Hand eczema is a common skin disease that can adversely affect the quality of life of patients. The aim of this study was to determine the quality of life in patients with hand eczema. This case-control study was performed on 70 patients with hand eczema and 70 healthy controls. All the patients filled out two questionnaires: Short Form 36 (SF-36) and Dermatology Life Quality index (DLQI). The data were analyzed using the statistical software package for social sciences (SPSS). The mean score score of quality of life in dimensions of physical functioning, vitality, and general health in the SF-36 was lower compared to the control group. The mean score in DLQI in patients with hand eczema was 8.68. There was a significant negative correlation between the scores of different dimensions of QOL obtained in the two questionnaires (SF36 and DLQI). The study demonstrated that the quality of life in patients with hand eczema was lower than that of controls. It seems advisable that psychiatric consultations or psychotherapy be included in the treatment of chronic hand eczema. PMID:24813839

Ghaderi, Reza; Saadatjoo, Alireza

2014-04-01

141

Mild Eczema Affects Self-perceived Health among Pre-adolescent Girls.  

PubMed

The aim was to assess the impact of eczema on health-related quality of life in the population-based birth cohort BAMSE with 2,756 pre-adolescent children. All answered the following questions on self-perceived health; "How are you feeling?", "How healthy do you consider yourself to be?" and "How happy are you with your life right now?". Children with ongoing eczema answered the "Children's Dermatology Life Quality Index (CDLQI)" questionnaire. In total, 350 (12.7%) of the children had eczema. Girls with eczema reported impaired self-perceived health as evaluated in the 3 questions; adjusted OR 1.72 (95% CI 1.16-2.55), 1.89 (95% CI 1.29-2.76) and 1.69 (95% CI 1.18-2.42). Eczema among boys was not associated with impairment of self-perceived health. The mean CDLQI score was 3.98 (95% CI 3.37-4.58). Since eczema affects up to 20% of pre-adolescent girls, the findings have implications both for health care providers and for society as a whole. PMID:24158408

Ballardini, Natalia; Ostblom, Eva; Wahlgren, Carl-Fredrik; Kull, Inger

2014-05-01

142

Experiences of carers managing childhood eczema and their views on its treatment: a qualitative study  

PubMed Central

Background Childhood eczema causes significant impact on quality of life for some families, yet non-concordance with treatment is common. Aim To explore parents' and carers' views of childhood eczema and its treatment. Design and setting Qualitative interview study in primary care in the south of England. Method Carers of children aged ?5 years with a recorded diagnosis of eczema, who reported that eczema was still a problem, were invited to participate. Thirty-one parents were interviewed from 28 families. Results Many parents expressed frustration with both medical care and prescribed treatments. They felt their child's suffering was not ‘taken seriously’, and experienced messages about a ‘trial and error’ prescribing approach and assurance that their child would ‘grow out of it’ as a further ‘fobbing off’, or dismissal. Many carers were ambivalent about eczema treatments, mainly topical corticosteroids but also emollients. Dietary exclusions as a potential cure were of interest to most families, although they perceived healthcare professionals as uninterested in this. Families varied in the extent to which they felt able to manage eczema and the length of time taken to gain control. In some instances, this was linked to not understanding advice or receiving conflicting advice from different healthcare providers. Conclusion Poor concordance with treatments seems unsurprising in the presence of such dissonance between carers' and healthcare providers' agendas. Acknowledging the impact of the condition, greater attention to how key messages are delivered and addressing carers' treatment beliefs are likely to improve engagement with effective self-care.

Santer, Miriam; Burgess, Hana; Yardley, Lucy; Ersser, Steven; Lewis-Jones, Sue; Muller, Ingrid; Hugh, Catherine; Little, Paul

2012-01-01

143

Prevalence of childhood eczema and food sensitization in the First Nations reserve of Natuashish, Labrador, Canada  

PubMed Central

Background The Mushua Innu of Natuashish, Labrador, Canada seem to have a high rate of childhood eczema. Anecdotally this problem seems to be more common now than 20 years ago. There has been speculation that this could be related to food sensitization that may have arisen coincident with a move away from a traditional Innu diet. We undertook to assess the prevalence and severity of pediatric eczema in Natuashish (population 792), and investigate the level of sensitization to common food antigens. Methods Over a three-month period we performed a population survey of all children in the community from the ages of 2–12 inclusive. The one-year prevalence of eczema was assessed using the United Kingdom Working Party’s diagnostic criteria, and graded on the Nottingham Severity Scale. All children with eczema and twice as many age/sex matched controls were offered complete blood counts, total IgE, and food specific IgE levels for egg white, cow’s milk protein and wheat. Results One hundred and eighty two (95% of the eligible children) were assessed. Of the 182 children examined eczema was diagnosed in 30 (16.5%) - 22 females and 8 males. The majority of children with eczema (20/30) were classified as being in the moderate and severe category. Of the 22 with eczema and 40 controls who consented to venipuncture all but 3 had IgE levels above the lab's reference range. Food specific antibody assays showed that 32, 23, and 5 percent of children with eczema were sensitized to egg, milk, and wheat respectively. None of the controls were sensitized. Conclusions The children of Natuashish, Labrador have a high rate of eczema, much of it graded as moderate or severe. IgE levels were markedly elevated in children with and without eczema, with average values at least ten-fold higher than other populations. There is no evidence of an unusual amount of sensitization to egg, milk or wheat.

2014-01-01

144

Why is community-associated MRSA spreading across the world and how will it change clinical practice?  

Microsoft Academic Search

Meticillin-resistant Staphylococcus aureus (MRSA) emerged in 1960 and over the following 40 years was a problem confined largely to the healthcare setting. In the late 1990s the first US reports of so-called community-associated MRSA (CA-MRSA) infections appeared. CA-MRSA infections were defined as MRSA infections occurring in patients who had no identifiable predisposing risk factors, such as healthy children and young

Matteo Bassetti; Elena Nicco; Malgorzata Mikulska

2009-01-01

145

MRSA in Africa: filling the global map of antimicrobial resistance.  

PubMed

We sought to assess the prevalence of methicillin-resistance among Staphylococcus aureus isolates in Africa. We included articles published in 2005 or later reporting for the prevalence of MRSA among S. aureus clinical isolates. Thirty-two studies were included. In Tunisia, the prevalence of MRSA increased from 16% to 41% between 2002-2007, while in Libya it was 31% in 2007. In South Africa, the prevalence decreased from 36% in 2006 to 24% during 2007-2011. In Botswana, the prevalence varied from 23-44% between 2000-2007. In Algeria and Egypt, the prevalence was 45% and 52% between 2003-2005, respectively. In Nigeria, the prevalence was greater in the northern than the southern part. In Ethiopia and the Ivory Coast, the prevalence was 55% and 39%, respectively. The prevalence of MRSA was lower than 50% in most of the African countries, although it appears to have risen since 2000 in many African countries, except for South Africa. PMID:23922652

Falagas, Matthew E; Karageorgopoulos, Drosos E; Leptidis, John; Korbila, Ioanna P

2013-01-01

146

A hierarchical spatial modelling approach to investigate MRSA transmission in a tertiary hospital  

PubMed Central

Background Most hospitals have a hierarchical design with beds positioned within cubicles and cubicles positioned within wards. Transmission of MRSA may be facilitated by patient proximity and thus the spatial arrangements of beds, cubicles and wards could be important in understanding MRSA transmission risk. Identifying high-risk areas of transmission may be useful in the design of more effective, targeted MRSA interventions. Methods Retrospective data on numbers of multi-resistant and non-multiresistant MRSA acquisitions were collected for 52 weeks in 2007 in a tertiary hospital in Brisbane, Australia. A hierarchical Bayesian spatio-temporal modelling approach was used to investigate spatial correlation in the hierarchically arranged datasets. The spatial component of the model decomposes cubicle-level variation into a spatially structured component and a spatially unstructured component, thereby encapsulating the influence of unmeasured predictor variables that themselves are spatially clustered and/or random. A fixed effect for the presence of another patient with the same type of MRSA in the cubicles two weeks prior was included. Results The best-fitting model for non-multiresistant MRSA had an unstructured random effect but no spatially structured random effect. The best-fitting model for multiresistant MRSA incorporated both spatially structured and unstructured random effects. While between-cubicle variability in risk of MRSA acquisition within the hospital was significant, there was only weak evidence to suggest that MRSA is spatially clustered. Presence of another patient with the same type of MRSA in the cubicles two weeks prior was a significant predictor of both types of MRSA in all models. Conclusions We found weak evidence of clustering of MRSA acquisition within the hospital. The presence of an infected patient in the same cubicle two weeks prior may support the importance of environmental contamination as a source of MRSA transmission.

2013-01-01

147

Role of rasayana in cure and prevention of recurrence of vicharchika (eczema).  

PubMed

Generally, skin diseases run a chronic course and the recurrence is very common. Mandip and Chandola (2009) reported that Shirishadi Decoction administered orally and simultaneously Snuhyadi Lepa applied externally to the patients of Vicharchika (Eczema) provided complete remission to 18.2% patients, marked improvement to 42.4% patients and moderate improvement to 36.4% patients but the recurrence rate was very high i.e. 80%. Charaka, in the context of the treatment of Apasmara mentions that in all the chronic diseases, Rasayana drugs should be prescribed. As eczema is a chronic disease and its recurrences are very common, therefore, it was thought desirable to evaluate the role of the Rasayana drugs in the cure and prevention of the recurrence of Vicharchika (Eczema). In this study, total 38 patients of Vicharchika (Eczema) were registered, among which 31 patients completed the full course of treatment. These patients were first subjected to Koshtha Shuddhi done with Aragvadha (Cassia fistula) Hima administered orally at bedtime for initial eight days. Thereafter 30 ml of Shirishadi Decoction and 6 gm of Guduchi (Tinospora cardifolia) and Bhringaraja (Eclipta alba) powder was given with Ghrita. Both the drugs were given twice daily after meals orally. Simultaneously, Snuhyadi Lepa was applied on the eczematous lesions. Results of the study showed that addition of Rasayana drugs provided complete remission to 22.6% and checked the recurrence of the disease in the 89.5% patients of Vicharchika (Eczema). PMID:22131682

Kaur, Mandip; Chandola, H M

2010-01-01

148

Role of Rasayana in Cure and Prevention of Recurrence of Vicharchika (Eczema)  

PubMed Central

Generally, skin diseases run a chronic course and the recurrence is very common. Mandip and Chandola (2009) reported that Shirishadi Decoction administered orally and simultaneously Snuhyadi Lepa applied externally to the patients of Vicharchika (Eczema) provided complete remission to 18.2% patients, marked improvement to 42.4% patients and moderate improvement to 36.4% patients but the recurrence rate was very high i.e. 80%. Charaka, in the context of the treatment of Apasmara mentions that in all the chronic diseases, Rasayana drugs should be prescribed. As eczema is a chronic disease and its recurrences are very common, therefore, it was thought desirable to evaluate the role of the Rasayana drugs in the cure and prevention of the recurrence of Vicharchika (Eczema). In this study, total 38 patients of Vicharchika (Eczema) were registered, among which 31 patients completed the full course of treatment. These patients were first subjected to Koshtha Shuddhi done with Aragvadha (Cassia fistula) Hima administered orally at bedtime for initial eight days. Thereafter 30 ml of Shirishadi Decoction and 6 gm of Guduchi (Tinospora cardifolia) and Bhringaraja (Eclipta alba) powder was given with Ghrita. Both the drugs were given twice daily after meals orally. Simultaneously, Snuhyadi Lepa was applied on the eczematous lesions. Results of the study showed that addition of Rasayana drugs provided complete remission to 22.6% and checked the recurrence of the disease in the 89.5% patients of Vicharchika (Eczema).

Kaur, Mandip; Chandola, H. M.

2010-01-01

149

Alitretinoin - its use in intractable hand eczema and other potential indications  

PubMed Central

Chronic hand eczema is a significant cause of morbidity. A number of treatments are traditionally used, and often useful, but in spite of this a sizeable group of patients develop chronic recalcitrant hand eczema. Retinoids are known to influence keratinization and inflammation, and acitretin has shown some effect in the treatment of chronic hand eczema. Alitretinoin (9-cis-retinoic acid) is a panagonist retinoid binding to all six known retinoid receptors (RAR-?, -?, -? and RXR-?, -?, -?). Several studies have been carried out with this new drug, and it has been shown to be effective in 28% to 89% of patients with previously intractable hand eczema. In addition, alitretinoin appears to have some potential in the treatment of AIDS-related Kaposi sarcoma. Attempts to use the drug in secondary prophylaxis has shown some promise in former tobacco smokers, whereas no effect was seen in patients with cervical intraepithelial neoplasia. Currently, the primary therapeutic potential of alitretinoin appears to be the treatment of chronic recalcitrant hand eczema, which also forms a large and hitherto neglected group of patients.

Petersen, Bibi; Jemec, Gregor BE

2009-01-01

150

Application of Information Technology: Rapid Identification of Hospitalized Patients at High Risk for MRSA Carriage  

Microsoft Academic Search

Patients who are asymptomatic carriers of methicillin-resistant Staphylococcus aureus (MRSA) are major reservoirs for transmission of MRSA to other patients. Medical personnel are usually not aware when these high-risk patients are hospitalized. We developed and tested an enterprise-wide electronic surveillance system to identify patients at high risk for MRSA carriage at hospital admission and during hospitalization. During a two-month study,

R. Scott Evans; Carrie Jane Wallace; James F. Lloyd; Caroline W. Taylor; Rouett H. Abouzelof; Sharon Sumner; Kyle V. Johnson; Amyanne Wuthrich; Stephan Harbarth; Matthew H. Samore

2008-01-01

151

Zero tolerance for healthcare-associated MRSA bacteraemia: is it realistic?  

PubMed Central

Background The term ‘zero tolerance’ has recently been applied to healthcare-associated infections, implying that such events are always preventable. This may not be the case for healthcare-associated infections such as methicillin-resistant Staphylococcus aureus (MRSA) bacteraemia. Methods We combined information from an epidemiological investigation and bacterial whole-genome sequencing to evaluate a cluster of five MRSA bacteraemia episodes in four patients in a specialist hepatology unit. Results The five MRSA bacteraemia isolates were highly related by multilocus sequence type (ST) (four isolates were ST22 and one isolate was a single-locus variant, ST2046). Whole-genome sequencing demonstrated unequivocally that the bacteraemia cases were unrelated. Placing the MRSA bacteraemia isolates within a local and global phylogenetic tree of MRSA ST22 genomes demonstrated that the five bacteraemia isolates were highly diverse. This was consistent with the acquisition and importation of MRSA from the wider referral network. Analysis of MRSA carriage and disease in patients within the hepatology service demonstrated a higher risk of both initial MRSA acquisition compared with the nephrology service and a higher risk of progression from MRSA carriage to bacteraemia, compared with patients in nephrology or geriatric services. A root cause analysis failed to reveal any mechanism by which three of five MRSA bacteraemia episodes could have been prevented. Conclusions This study illustrates the complex nature of MRSA carriage and bacteraemia in patients in a specialized hepatology unit. Despite numerous ongoing interventions to prevent MRSA bacteraemia in healthcare settings, these are unlikely to result in a zero incidence in referral centres that treat highly complex patients.

Torok, M. Estee; Harris, Simon R.; Cartwright, Edward J. P.; Raven, Kathy E.; Brown, Nicholas M.; Allison, Michael E. D.; Greaves, Daniel; Quail, Michael A.; Limmathurotsakul, Direk; Holden, Matthew T. G.; Parkhill, Julian; Peacock, Sharon J.

2014-01-01

152

Community-Acquired MRSA Infections in North Carolina Children: Prevalence, Antibiotic Sensitivities, and Risk Factors  

Microsoft Academic Search

Background: The incidence of community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) infections in children has increased dramatically over the past decade. CA-MRSA infections are often resistant to standard outpatient antibiotics and present a large burden to the health care system and to afflicted families. Objectives: Our aims were to characterize the patterns of CA-MRSA resistance to common antibiotics and to identify significant

Adam Shapiro; Sudha Raman; Marilee Johnson; Mark Piehl

153

Are There Better Methods of Monitoring MRSA Control than Bacteraemia Surveillance? An Observational Database Study  

PubMed Central

Background Despite a substantial burden of non-bacteraemic methicillin resistant Staphylococcus aureus (MRSA) disease, most MRSA surveillance schemes are based on bacteraemias. Using bacteraemia as an outcome, trends at hospital level are difficult to discern, due to random variation. We investigated rates of nosocomial bacteraemic and non-bacteraemic MRSA infection as surveillance outcomes. Methods and Findings We used microbiology and patient administration system data from an Oxford hospital to estimate monthly rates of first nosocomial MRSA bacteraemia, and nosocomial MRSA isolation from blood/respiratory/sterile site specimens (“sterile sites”) or all clinical samples (screens excluded) in all patients admitted from the community for at least 2 days between April 1998 and June 2006. During this period there were 441 nosocomial MRSA bacteraemias, 1464 MRSA isolations from sterile sites, and 3450 isolations from clinical specimens (8% blood, 15% sterile site, 10% respiratory, 59% surface swabs, 8% urine) in over 2.6 million patient-days. The ratio of bacteraemias to sterile site and all clinical isolations was similar over this period (around 3 and 8-fold lower respectively), during which rates of nosocomial MRSA bacteraemia increased by 27% per year to July 2003 before decreasing by 18% per year thereafter (heterogeneity p<0.001). Trends in sterile site and all clinical isolations were similar. Notably, a change in rate of all clinical MRSA isolations in December 2002 could first be detected with conventional statistical significance by August 2003 (p?=?0.03). In contrast, when monitoring MRSA bacteraemia, identification of probable changes in trend took longer, first achieving p<0.05 in July 2004. Conclusions MRSA isolation from all sites of suspected infection, including bacteraemic and non-bacteraemic isolation, is a potential new surveillance method for MRSA control. It occurs about 8 times more frequently than bacteraemia, allowing robust statistical determination of changing rates over substantially shorter times or smaller areas than using bacteraemia as an outcome.

Walker, Sarah; Peto, Tim E. A.; O'Connor, Lily; Crook, Derrick W.; Wyllie, David

2008-01-01

154

Different Trends of MRSA and VRE in a German Hospital, 1999–2005  

Microsoft Academic Search

Some of the clinically most menacing nosocomial pathogens are Methicillin-resistent Staphylococcus aureus (MRSA) and Vancomycin-resistent\\u000a Enterococcus (VRE). During the last years both pathogens showed dramatic increases in colonization and infection rates in\\u000a Germany. This study covers all patients positively tested for MRSA and VRE in a German University Hospital from 1999–2005.\\u000a About 1,179 MRSA cases and 116 VRE cases have

C. Goll; P. Balmer; F. Schwab; H. Rüden; T. Eckmanns

2007-01-01

155

Risk factors and gene type for infections of MRSA in diabetic foot patients in Tianjin, China.  

PubMed

The objective was to study risk factors and gene type of DF patients infected with MRSA. A total of 429 DF patients were recruited. The patients with S aureus infections were divided into MRSA and MSSA groups. MRSA were genotyped by SCCmec. pvl and lukE-lukD were detected. A total of 559 pathogens were isolated from them, with G+ bacteria firstly(59.0%), followed G- bacilli (37.7%) and true fungi (3.3%). The 3 most frequently isolated pathogens were S aureus (35.2%), S epidermidis (12.3%), and Pseudomonas aeruginosa (11.2%). SCCmec III MRSA and SCCmec IVa MRSA had the same antibacterial spectrum. mecA positive rate was 100%. lukE-lukD and pvl positive rates were 100% and 0%, respectively. 28 strains belonged to SCCmec III and the others belonged to SCCmec IVa. The G+ cocci were the main pathogens, S aureus and S epidermidis were predominant among them. Antibiotic usage in 6 months prior to hospitalization, long course of ulcer, osteomyelitis and hypoproteinemia are risk factors for MRSA. SCCmec IVa is high in proportion to MRSA isolates, suggesting that CA-MRSA has become major pathogen of DF infection. All the MRSA were harboring lukE-lukD, which has been reported to present poor leucotoxin compared to pvl, and may be a response to atypical local inflammatory reaction in DF infection. PMID:23771611

Feng, Shu-Hong; Chu, Yue-Jie; Wang, Peng-Hua; Jun, Xu; Min, Ding; Li, Xue-Mei

2013-06-01

156

MRSA distribution and epidemiological procedures evaluation at two hospitals in Northern Poland.  

PubMed

In the present study we have analyzed the impact of modified MRSA screening of carriers and patients on epidemiological situation of MRSA during 2008-2010, comparing two regional hospitals with similar bed numbers and similar ward profiles in Northern Poland. In 2008 the proportion of MRSA to all S. aureus isolates was 14.4% resp. 6.0%, in 2009 8.3% resp. 4.7% and in 2010 6.5% in both hospitals. Independent of the different prevention and intervention strategy in both hospitals the different MRSA incidence seems to be due to regional epidemic settings. PMID:22242100

Paszko, Krystyna; Michnowska, Ewa; Kurlenda, Julianna; Grinholc, Mariusz; Nakonieczna, Joanna; Bielawski, Krzysztof Piotr

2011-01-01

157

MRSA distribution and epidemiological procedures evaluation at two hospitals in Northern Poland  

PubMed Central

In the present study we have analyzed the impact of modified MRSA screening of carriers and patients on epidemiological situation of MRSA during 2008–2010, comparing two regional hospitals with similar bed numbers and similar ward profiles in Northern Poland. In 2008 the proportion of MRSA to all S. aureus isolates was 14.4% resp. 6.0%, in 2009 8.3% resp. 4.7% and in 2010 6.5% in both hospitals. Independent of the different prevention and intervention strategy in both hospitals the different MRSA incidence seems to be due to regional epidemic settings

Paszko, Krystyna; Michnowska, Ewa; Kurlenda, Julianna; Grinholc, Mariusz; Nakonieczna, Joanna; Bielawski, Krzysztof Piotr

2011-01-01

158

CC8 MRSA Strains Harboring SCCmec Type IVc are Predominant in Colombian Hospitals  

PubMed Central

Background Recent reports highlight the incursion of community-associated MRSA within healthcare settings. However, knowledge of this phenomenon remains limited in Latin America. The aim of this study was to evaluate the molecular epidemiology of MRSA in three tertiary-care hospitals in Medellín, Colombia. Methods An observational cross-sectional study was conducted from 2008–2010. MRSA infections were classified as either community-associated (CA-MRSA) or healthcare-associated (HA-MRSA), with HA-MRSA further classified as hospital-onset (HAHO-MRSA) or community-onset (HACO-MRSA) according to standard epidemiological definitions established by the U.S. Centers for Disease Control and Prevention (CDC). Genotypic analysis included SCCmec typing, spa typing, PFGE and MLST. Results Out of 538 total MRSA isolates, 68 (12.6%) were defined as CA-MRSA, 243 (45.2%) as HACO-MRSA and 227 (42.2%) as HAHO-MRSA. The majority harbored SCCmec type IVc (306, 58.7%), followed by SCCmec type I (174, 33.4%). The prevalence of type IVc among CA-, HACO- and HAHO-MRSA isolates was 92.4%, 65.1% and 43.6%, respectively. From 2008 to 2010, the prevalence of type IVc-bearing strains increased significantly, from 50.0% to 68.2% (p?=?0.004). Strains harboring SCCmec IVc were mainly associated with spa types t1610, t008 and t024 (MLST clonal complex 8), while PFGE confirmed that the t008 and t1610 strains were closely related to the USA300-0114 CA-MRSA clone. Notably, strains belonging to these three spa types exhibited high levels of tetracycline resistance (45.9%). Conclusion CC8 MRSA strains harboring SCCmec type IVc are becoming predominant in Medellín hospitals, displacing previously reported CC5 HA-MRSA clones. Based on shared characteristics including SCCmec IVc, absence of the ACME element and tetracycline resistance, the USA300-related isolates in this study are most likely related to USA300-LV, the recently-described ‘Latin American variant’ of USA300.

Jimenez, J. Natalia; Ocampo, Ana M.; Vanegas, Johanna M.; Rodriguez, Erika A.; Mediavilla, Jose R.; Chen, Liang; Muskus, Carlos E.; A. Velez, Lazaro; Rojas, Carlos; Restrepo, Andrea V.; Ospina, Sigifredo; Garces, Carlos; Franco, Liliana; Bifani, Pablo; Kreiswirth, Barry N.; Correa, Margarita M.

2012-01-01

159

Long-term persistence of MRSA in re-admitted patients  

PubMed Central

Background A better knowledge of methicillin-resistant Staphylococcus aureus (MRSA) persistence in hospitalised patients may impact on specific prevention strategies. We have investigated the persistence of MRSA-carriage in patients admitted and re-admitted to a university hospital. Patients and methods Between January 2002 and October 2005 all MRSA-positive patients admitted to the university hospital of Hannover Medical School were assessed at first admission and all subsequent re-admissions. Patients re-admitted at least once were analysed for the persistence or loss of MRSA. The association of possible factors influencing the persistence of MRSA colonisation or infection (age group, gender, decolonisation therapy during first hospital stay due to MRSA positivity and colonisation of different anatomical sites) was analysed using univariate, multivariate and time-dependent analyses. Results A total of 1,032 patients who had tested positive at least once for MRSA were admitted to our hospital during the study period, accounting for 2,038 admissions. Of these patients, 403 (39.1%) were admitted more than once (from two times to 21 times), and 238 (59.1%) of the re-admitted patients remained MRSA positive during all subsequent admissions. Fifty-five (13.6%) patients tested MRSA negative at their last admission, and 61 (15.1%) tested MRSA negative at at least two consecutive admissions. In 27 (6.7%) patients, the MRSA status differed more than once between subsequent admissions. Overall, the half-life time (HLT) of MRSA persistence was 549 days, with the duration of persistence dependent on the colonisation of different anatomical sites (HLT only wounds 117 days; HLT mouth, throat, bronchial secretions 627 days; HLT nose, wounds and other body sites 801 days; p < 0.01) and was prolonged if more than one body site was MRSA-positive (HR 2.18, 95% confidence interval 1.52–3.15). Conclusion A detailed knowledge of the dynamics of the loss of MRSA infection could result in a reduction of the incidence of MRSA in the future. Multiple anatomical site carriage of MRSA appeared to predict a prolonged persistence in our cohort of patients re-admitted to a university hospital.

Biertz, F.; Ziesing, S.; Gastmeier, P.; Chaberny, I. F.

2010-01-01

160

Development of Questionnaires on Coping with Disease and Itching Cognitions for Children and Adolescents with Atopic Eczema  

Microsoft Academic Search

SummaryBackground: There are numerous questionnaires for adults to assess coping with disease and quality of life in patients with atopic eczema, but there are hardly any for children and adolescents. This is surprising because the prevalence of atopic eczema is higher in these age groups than in adults. Moreover, the patients in this age range are in a sensitive phase

J. Kupfer; P. Keins; B. Brosig; U. Darsow; T. L. Diepgen; M. Fartasch; E. Korsch; T. Lob-Corzilius; V. Niemeier; R. Scheidt; G. Schmid-Ott; D. Staab; R. Szczepanski; T. Werfel; M. Wittenmeier; U. Gieler

2003-01-01

161

Worldwide variations in the prevalence of symptoms of atopic eczema in the international study of asthma and allergies in childhood  

Microsoft Academic Search

Background: Little is known about the prevalence of atopic eczema outside Northern Europe. Objectives: We sought to describe the magnitude and variation in the prevalence of atopic eczema symptoms throughout the world. Methods: A cross-sectional questionnaire survey was conducted on random samples of schoolchildren aged 6 to 7 years and 13 to 14 years from centers in 56 countries throughout

Hywel Williams; Colin Robertson; Alistair Stewart; Nadia Aït-Khaled; Gabriel Anabwani; Ross Anderson; Innes Asher; Richard Beasley; Bengt Björkstén; Michael Burr; Tadd Clayton; Julian Crane; Philippa Ellwood; Ulrich Keil; Chris Lai; Javier Mallol; Fernando Martinez; Edwin Mitchell; Stephen Montefort; Neil Pearce; Jayant Shah; Bonnie Sibbald; David Strachan; Erika von Mutius; Stephan K. Weiland

1999-01-01

162

Predictors of clinical and microbiological treatment failure in patients with methicillin-resistant Staphylococcus aureus (MRSA) bacteraemia: a retrospective cohort study in a region with low MRSA prevalence.  

PubMed

Invasive infections with methicillin-resistant Staphylococcus aureus (MRSA) have been associated with increased morbidity and mortality. The aim of the present study was to identify independent predictors of early mortality and treatment failure in patients with MRSA bacteraemia. A total of 132 adult patients who developed MRSA bacteraemia during hospitalization in the University Hospital of Vienna between 2000 and 2011 were screened and 124 were included in a retrospective cohort study. Patient demographics, source of bacteraemia, antimicrobial treatment and microbiological characteristics were evaluated. The 28-day crude mortality was 30.6%. Predictors of early mortality identified in multivariate Cox regression analysis included higher patient age (adjusted hazard ratio (aHR) 1.03, 95% CI 1.01-1.06, p 0.006), pneumonia (aHR 3.86, 95% CI 1.83-8.12, p <0.001) and failure to use MRSA active treatment (aHR 8.77, 95% CI 3.50-21.93, p <0.001). Ninety-one (73.4%) patients received glycopeptides as specific MRSA treatment. Of 63 patients treated with vancomycin, only 14 (22.6%) patients had aimed trough levels of 15-20 mg/L. Vancomycin MIC ?2 mg/L was detected in 28.2% and was associated with glycopeptide pretreatment (p 0.001). All MRSA isolates were susceptible to linezolid and tigecycline. Persistent bacteraemia ?7 days was documented in 25 (20.2%) patients. Independent determinants for microbiological eradication failure in patients with MRSA bacteraemia included endocarditis (p <0.001) and vancomycin trough levels (p 0.014), but not vancomycin MIC. Failure of clinical and microbiological eradication of MRSA among patients with MRSA bacteraemia was associated with clinical entity rather than with bacterial traits. Pharmacokinetic parameters seem to be decisive on microbiological and clinical success. PMID:23490021

Forstner, C; Dungl, C; Tobudic, S; Mitteregger, D; Lagler, H; Burgmann, H

2013-07-01

163

The Hand Eczema Trial (HET): design of a randomised clinical trial of the effect of classification and individual counselling versus no intervention among health-care workers with hand eczema  

PubMed Central

Background Hand eczema is the most frequently recognized occupational disease in Denmark with an incidence of approximately 0.32 per 1000 person-years. Consequences of hand eczema include chronic severe eczema, prolonged sick leave, unemployment, and impaired quality of life. New preventive strategies are needed to reduce occupational hand eczema. Methods/Design We describe the design of a randomised clinical trial to investigate the effects of classification of hand eczema plus individual counselling versus no intervention. The trial includes health-care workers with hand eczema identified from a self-administered questionnaire delivered to 3181 health-care workers in three Danish hospitals. The questionnaire identifies the prevalence of hand eczema, knowledge of skin-protection, and exposures that can lead to hand eczema. At entry, all participants are assessed regarding: disease severity (Hand Eczema Severity Index); self-evaluated disease severity; number of eruptions; quality of life; skin protective behaviour, and knowledge of skin protection. The patients are centrally randomised to intervention versus no intervention 1:1 stratified for hospital, profession, and severity score. The experimental group undergoes patch and prick testing; classification of the hand eczema; demonstration of hand washing and appliance of emollients; individual counselling, and a skin-care programme. The control group receives no intervention. All participants are reassessed after six months. The primary outcome is observer-blinded assessment of disease severity and the secondary outcomes are unblinded assessments of disease severity; number of eruptions; knowledge of skin protection; skin-protective behaviour, and quality of life. Trial registration The trial is registered in ClinicalTrials.Gov, NCT01012453.

2010-01-01

164

Prevalence and risk factors of atopic eczema in Turkish adolescents.  

PubMed

Atopic eczema (AE) is the most common childhood inflammatory skin condition. The aim of this study was to evaluate the prevalence of AE and its relation to various risk factors. In a cross-sectional study, 9,991 children ages 13 to 14 years in 61 primary schools in 32 districts of Istanbul were evaluated. The prevalence of AE and associated symptoms was assessed using the International Study of Asthma and Allergies in Childhood protocol. The relationship between risk factors and AE was evaluated using multivariate logistic regression analysis. Ten thousand nine hundred eighty-four questionnaires were distributed to 13- and 14-year-old children in 61 schools in 32 districts of Istanbul, 9,991 of which were suitable for analysis, for an overall response rate of 91.7%. There were 4,746 boys (47.9%) and 5,166 girls (52.1%) (M/F ratio 0.920). The rates of itchy rash ever, 12-month itchy rash, and doctor-diagnosed AE ever were 18.2%, 12.0%, and 2.8%, respectively. The difference between rates for itchy rash ever, 12-month itchy rash and doctor-diagnosed AE was high (12.8-31.3, 5.8-24.8, and 0-17.2, respectively) between the districts of Istanbul. Female sex, AE family history, watching television more than 5 hours a day, region of the district, and tonsillectomy history were found to be significantly associated with doctor-diagnosed AE at p < 0.05 in multivariate analysis. This study found a low prevalence of doctor-diagnosed AE and related symptoms in Istanbul. Several risk factors were found to be associated with doctor-diagnosed AE. PMID:24475933

Akcay, Ahmet; Tamay, Zeynep; Ergin, Ahmet; Guler, Nermin

2014-01-01

165

Fusidic acid in skin infections and infected atopic eczema.  

PubMed

Skin infections represent an important public health issue and cost-driver. Additionally, chronic skin lesions are sometimes colonized by Gram-negative species. Topical therapies are a key component in the management of mild-to-moderate skin infections. In such cases, topical antibiotics may be preferable to systemic treatment, since they maximize the effective doses at the site of infection while minimizing the systemic side effects of the drugs. However, the prevalence of resistant strains is steadily increasing and cases of sensitization are not uncommon. As a consequence, the ideal topical antibiotic should be selective (thus, minimizing cross-resistance), have weak sensitization potential, penetrate the skin efficiently, reach adequate local doses at the site of infection, and finally be available in different formulations matching patients' preferences and needs. Fusidic acid (FA) is a selective antibiotic available in several topical formulations. Pharmacokinetic and pharmacodynamic studies have shown that, contrary to other topical antibiotics such as gentamicin or mupirocin, FA reaches high antimicrobial concentration at deep skin layers after topical application either on intact or damaged epidermis. Several randomized controlled trials demonstrated that FA, in its various topical formulations, is very effective in treating skin infections, given its high bactericidal activity against S. aureus (including strains resistant to penicillin, methicillin, ampicillin, cloxacillin), S. epidermidis, Streptococcus pyogenes, Propionibacterium acnes, Corinebatteria, Clostridia. Additionally, FA presents a low risk of resistance even in methicillin-resistant S. aureus strains, a common pathogen implied in the etiology of skin infections and infected atopic eczema. Such feature makes FA particularly useful in the management of these medical conditions. Finally, possibly due to its large steric effect, FA has proved a very low risk of contact sensitization. Overall, data on FA efficacy, safety, sensitization potential, resistance profile and spectrum selectivity make it a first-choice option in the treatment of primary and secondary skin infection. PMID:25068235

Bonamonte, D; Belloni Fortina, A; Neri, L; Patrizi, A

2014-08-01

166

Evolution of MRSA During Hospital Transmission and Intercontinental Spread  

PubMed Central

Current methods for differentiating isolates of predominant lineages of pathogenic bacteria often do not provide sufficient resolution to define precise relationships. Here, we describe a high-throughput genomics approach that provides a high-resolution view of the epidemiology and microevolution of a dominant strain of methicillin-resistant Staphylococcus aureus (MRSA). This approach reveals the global geographic structure within the lineage, its intercontinental transmission through four decades, and the potential to trace person-to-person transmission within a hospital environment. The ability to interrogate and resolve bacterial populations is applicable to a range of infectious diseases, as well as microbial ecology.

Harris, Simon R.; Feil, Edward J.; Holden, Matthew T. G.; Quail, Michael A.; Nickerson, Emma K.; Chantratita, Narisara; Gardete, Susana; Tavares, Ana; Day, Nick; Lindsay, Jodi A.; Edgeworth, Jonathan D.; de Lencastre, Herminia; Parkhill, Julian; Peacock, Sharon J.; Bentley, Stephen D.

2010-01-01

167

Severe Eczema in Infancy Can Predict Asthma Development. A Prospective Study to the Age of 10 Years  

PubMed Central

Background Children with atopic eczema in infancy often develop allergic rhinoconjunctivitis and asthma, but the term “atopic march” has been questioned as the relations between atopic disorders seem more complicated than one condition progressing into another. Objective In this prospective multicenter study we followed children with eczema from infancy to the age of 10 years focusing on sensitization to allergens, severity of eczema and development of allergic airway symptoms at 4.5 and 10 years of age. Methods On inclusion, 123 children were examined. Hanifin-Rajka criteria and SCORAD index were used to describe the eczema. Episodes of wheezing were registered, skin prick tests and IgE tests were conducted and questionnaires were filled out. Procedures were repeated at 4.5 and 10 years of age with additional examinations for ARC and asthma. Results 94 out of 123 completed the entire study. High SCORAD points on inclusion were correlated with the risk of developing ARC, (B?=?9.86, P?=?0.01) and asthma, (B?=?10.17, P?=?0.01). For infants with eczema and wheezing at the first visit, the OR for developing asthma was 4.05(P?=?0.01). ARC at 4.5 years of age resulted in an OR of 11.28(P?=?0.00) for asthma development at 10 years. Conclusion This study indicates that infant eczema with high SCORAD points is associated with an increased risk of asthma at 10 years of age. Children with eczema and wheezing episodes during infancy are more likely to develop asthma than are infants with eczema alone. Eczema in infancy combined with early onset of ARC seems to indicate a more severe allergic disease, which often leads to asthma development. The progression from eczema in infancy to ARC at an early age and asthma later in childhood shown in this study supports the relevance of the term “atopic march”, at least in more severe allergic disease.

Ekback, Marie; Tedner, Michaela; Devenney, Irene; Oldaeus, Goran; Norrman, Gunilla; Stromberg, Leif; Falth-Magnusson, Karin

2014-01-01

168

Patients presenting to the hospital with MRSA pneumonia: differentiating characteristics and outcomes with empiric treatment  

PubMed Central

Background Concern for MRSA in patients presented to the hospital with pneumonia may be overestimated leading to excessive prescribing of empiric anti-MRSA therapy. This study aims to identify at-risk patients and treatment outcomes. Methods Adults hospitalized during 2005–2011 with pneumonia diagnosed within 48 h of admission were included. Medical charts were retrospectively reviewed for relevant data. Patients with MRSA were matched 1:1 to those with non-MRSA pathogen or negative culture. A published risk scoring system for MRSA pneumonia was applied. Results 268 elderly patients were included, 134 patients in each group. Compared to non-MRSA group, MRSA patients presented more acutely ill (p?MRSA. A history of MRSA infection or pneumonia differentiated the latter group. Most MRSA patients (66%, 88/134) were treated empirically (primarily vancomycin) but outcome was not improved by receipt of empiric therapy. Conclusions Use of a published risk scoring scheme with additional variables from this study can potentially reduce overprescribing of anti-MRSA empiric therapy in patients presented to the hospital with pneumonia. Prospective studies evaluating the treatment benefit of non-vancomycin alternatives as empiric therapy are needed.

2014-01-01

169

MRSA screening in orthopaedic surgery: clinically valuable and cost effective? A prospective analysis of 8,867 patients.  

PubMed

This study aimed at assessing the prevalence of MRSA colonisation in Trauma and Orthopaedics. Risk factors, decolonisation, and subsequent infection rates were investigated. Cost-analysis of the MRSA screening program was performed. The validity and effectiveness of the MRSA screening program was reviewed. A prospective analysis was made of all orthopaedic admissions in East Lancashire Hospital Trust. A total number of 13,155 swabs were taken in 8,867 patients in 2010. This MRSA screening program was compared to the ideal screening criteria set out by Wilson and Junger (WHO 1968). The MRSA prevalence in Trauma and Orthopaedics in 2010 was 0.47%. The decolonisation rate was 55%. There was no correlation between MRSA colonisation and subsequent infection. The total cost of MRSA screening at ELHT was calculated as a minimum of 184,170 Pounds. This could extrapolate to a national expense of around 16 million pounds in England and Wales in Orthopaedics alone. The MRSA screening program did not meet 4 out of 9 screening criteria of Wilson and Junger. The vast majority of Trauma and Orthopaedic patients are not at risk of MRSA colonisation or infection and therefore should not be screened. MRSA infection is a risk in certain high risk groups which should be screened. The MRSA screening program is ineffective when assessed to WHO standards. The program should be considered to be surveillance of MRSA, not an effective screening program for pathological MRSA infection. PMID:24205779

Barkatali, Bilal M; Heywood, Nick; White, Ruth; Paton, Robin W

2013-08-01

170

Impact of MRSA Decolonization Therapy on MRSA Infection and Transmission. Inclusive Project Dates: 07/01/11 - 04/30/13.  

National Technical Information Service (NTIS)

The purpose of this study was to compare the effectiveness of standard patient isolation during the hospital stay with placebo decolonization, to a strategy of isolation and active decolonization for hospital inpatients colonized with MRSA with respect to...

A. G. Mainous

2013-01-01

171

The economic burden of community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA).  

PubMed

The economic impact of community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) remains unclear. We developed an economic simulation model to quantify the costs associated with CA-MRSA infection from the societal and third-party payer perspectives. A single CA-MRSA case costs third-party payers $2277-$3200 and society $7070-$20 489, depending on patient age. In the United States (US), CA-MRSA imposes an annual burden of $478 million to 2.2 billion on third-party payers and $1.4-13.8 billion on society, depending on the CA-MRSA definitions and incidences. The US jail system and Army may be experiencing annual total costs of $7-11 million ($6-10 million direct medical costs) and $15-36 million ($14-32 million direct costs), respectively. Hospitalization rates and mortality are important cost drivers. CA-MRSA confers a substantial economic burden on third-party payers and society, with CA-MRSA-attributable productivity losses being major contributors to the total societal economic burden. Although decreasing transmission and infection incidence would decrease costs, even if transmission were to continue at present levels, early identification and appropriate treatment of CA-MRSA infections before they progress could save considerable costs. PMID:22712729

Lee, B Y; Singh, A; David, M Z; Bartsch, S M; Slayton, R B; Huang, S S; Zimmer, S M; Potter, M A; Macal, C M; Lauderdale, D S; Miller, L G; Daum, R S

2013-06-01

172

Limited effectiveness of chlorhexidine based hand disinfectants against methicillin-resistant Staphylococcus aureus (MRSA)  

Microsoft Academic Search

Hand disinfectants containing chlorhexidine are thought to be less bactericidal against methicillin-resistant Staphylococcus aureus (MRSA) than methicilhn-susceptible Staphylococcus aureus (MSSA). We report an in vitro comparison between three distinct MRSA strains and three MSSA strains. The bactericidal efficacy of chlorhexidine digluconate, ‘Hibiscrub’ and ‘Hibisol’ against Staphylococcus aureus was determined in a quantitative suspension test. Logarithmic reduction factors (RF) were calculated

G. Kampf; R. Jarosch; H. Rüden

1998-01-01

173

Riktlinjer avseende handläggning av MRSA för personal i patientnära vårdarbete i Stockholms läns landsting  

Microsoft Academic Search

Meticillinresistenta Staphylococcus aureus (MRSA) har under de senaste åren blivit ett ökande problem inom vården. De följande riktlinjerna avser handläggning av MRSA för personal i patientnära vårdarbete. Patientnära vårdarbete definieras som arbete i rum där patienter undersöks, behandlas eller vårdas. Även om det är ovanligt händer det att en medarbetare blir \\

Sören Olofsson; Eva Tillman; Ordförande Åke Örtqvist

2006-01-01

174

Prevalence and risk factor analysis of livestock associated MRSA-positive pig herds in The Netherlands.  

PubMed

In 2005, methicillin-resistant Staphylococcus aureus was found in pig herds and in humans in contact with pigs. To determine the prevalence of, this now-called livestock-associated (LA) MRSA among pig herds in The Netherlands and to identify and quantify risk factors, an observational study of 202 pig herds was performed between 2007 and 2008. Five environmental wipes and 60 nasal swabs from each herd were collected, and microbiological analysis was performed on single environmental samples and pooled nasal samples. A herd was considered MRSA-positive if ?1 sample tested positive. The prevalence of MRSA-positive herds was 67% in breeding herds and 71% in finishing herds. Multivariable logistic regression analysis was then performed on data from 171 breeding herds. The number of MRSA-positive herds increased from ?30% at the start to ?75% at the end of the study, most likely due to transmission between herds. The prevalence of MRSA increased with herd size, as ?40% of smaller herds (<250 sows) were MRSA-positive compared to >80% of larger herds (>500 sows). Other risk factors (e.g. antimicrobial use, purchase of gilts and hygiene measures) were not significantly associated with MRSA, though associated with herd size. Herd size appeared to be a compilation of several factors, which made larger herds more often MRSA positive. PMID:21733585

Broens, E M; Graat, E A M; Van der Wolf, P J; Van de Giessen, A W; De Jong, M C M

2011-10-01

175

System-wide Surveillance for Clinical Encounters by Patients Previously Identified with MRSA and VRE  

Microsoft Academic Search

Methicillin-resistant Staphylococcus aureus (MRSA) and vanco- mycin-resistant Enterococci (VRE) have emerged as major in- fection control problems worldwide. Patients previously infected or colonized with MRSA or VRE need to be identified and often isolated as soon as they visit a health care facility. In- fection control personnel usually are not aware when these pa- tients enter their facilities. We developed

R. Scott Evansab; James F. Lloyda; Caroline W. Taylorc; Vickie R. Andersond; Matthew H. Samorebe; R. Scott Evans; James F. Lloyd; Rouett H. Abouzelof; Caroline W. Taylor; Vickie R. Anderson; Matthew H. Samore

2004-01-01

176

An Ex Vivo Porcine Nasal Mucosa Explants Model to Study MRSA Colonization  

PubMed Central

Staphylococcus aureus is an opportunistic pathogen able to colonize the upper respiratory tract and skin surfaces in mammals. Methicillin-resistant S. aureus ST398 is prevalent in pigs in Europe and North America. However, the mechanism of successful pig colonization by MRSA ST398 is poorly understood. To study MRSA colonization in pigs, an ex vivo model consisting of porcine nasal mucosa explants cultured at an air-liquid interface was evaluated. In cultured mucosa explants from the surfaces of the ventral turbinates and septum of the pig nose no changes in cell morphology and viability were observed up to 72 h. MRSA colonization on the explants was evaluated followed for three MRSA ST398 isolates for 180 minutes. The explants were incubated with 3×108 CFU/ml in PBS for 2 h to allow bacteria to adhere to the explants surface. Next the explants were washed and in the first 30 minutes post adhering time, a decline in the number of CFU was observed for all MRSA. Subsequently, the isolates showed either: bacterial growth, no growth, or a further reduction in bacterial numbers. The MRSA were either localized as clusters between the cilia or as single bacteria on the cilia surface. No morphological changes in the epithelium layer were observed during the incubation with MRSA. We conclude that porcine nasal mucosa explants are a valuable ex vivo model to unravel the interaction of MRSA with nasal tissue.

Tulinski, Pawel; Fluit, Ad C.; van Putten, Jos P. M.; de Bruin, Alain; Glorieux, Sarah; Wagenaar, Jaap A.; Duim, Birgitta

2013-01-01

177

Molecular epidemiology and characterisation of MRSA isolates from Trinidad and Tobago.  

PubMed

Eighty methicillin-resistant Staphylococcus aureus (MRSA) isolates from three hospitals in Trinidad and Tobago were collected and genotyped using microarray hybridisation. They were found to belong to three distinct MRSA strains. Of the 80 isolates, 76 were assigned to ST239-MRSA-III. They were largely homogeneous, although some variations affected the presence of the enterotoxin A gene, as well as of resistance markers (mercury resistance operon, aadD, tet(K), qacA). The mupA gene conferring mupirocin resistance was found in 7.3% of isolates. One isolate was identified as CC5-MRSA-II and three isolates belonged to the Panton-Valentine leukocidin (PVL)-positive ST8-MRSA-IV strain USA300. While community-acquired MRSA strains are rare in Trinidad and Tobago, the vast majority of MRSA cases can be attributed to healthcare-associated strains. Thus, infection control procedures within medical facilities need to be revised and enforced. This could substantially reduce the burden of MRSA to healthcare in Trinidad and Tobago. PMID:22068275

Monecke, S; Nitschke, H; Slickers, P; Ehricht, R; Swanston, W; Manjunath, M; Roberts, R; Akpaka, P E

2012-07-01

178

Prevalence and molecular characteristics of methicillin-resistant Staphylococcus aureus (MRSA) among pigs on German farms and import of livestock-related MRSA into hospitals  

Microsoft Academic Search

The aim of this study was to evaluate the prevalence and molecular characteristics of methicillin-resistant Staphylococcus aureus (MRSA) among pigs and estimate the impact of this animal reservoir on human healthcare. Nasal swabs were derived from 1,600\\u000a pigs at 40 German farms. The MRSA were characterized using S. aureus protein A (spa) typing, multilocus sequence typing (MLST) and detection of

R. Köck; J. Harlizius; N. Bressan; R. Laerberg; L. H. Wieler; W. Witte; R. H. Deurenberg; A. Voss; K. Becker; A. W. Friedrich

2009-01-01

179

Replacement of HA-MRSA by CA-MRSA Infections at an Academic Medical Center in the Midwestern United States, 2004-5 to 2008  

PubMed Central

We noted anecdotally that infections designated as health care-associated (HA-) MRSA by epidemiologic criteria seemed to be decreasing in incidence at the University of Chicago Medical Center (UCMC) after 2004. We compared MRSA patients seen at any site of clinical care at UCMC and the isolates that caused their infections in 2004-5 (n?=?545) with those in 2008 (n?=?135). The percent of patients with MRSA infections cultured > 2 days after hospital admission decreased from 19.5% in 2004-5 to 7.4% in 2008 (p?=?0.001). The percent in 2004-5 compared with 2008 who had a hospitalization (49.1% to 26.7%, p?=?0.001) or surgery (43.0% to 14.1%, p<0.001) in the previous year decreased. In 2008 a greater percent of patients was seen in the emergency department (23.1% vs. 39.3%) and a smaller percent both in intensive care units (15.6% vs. 6.7%) and in other inpatient units (40.7% vs. 32.6%) (p<0.001). The percent of patients with CA-MRSA infections by the CDC epidemiologic criteria increased from 36.5% in 2004-5 to 62.2% in 2008 (p<0.001). The percent of MRSA isolates sharing genetic characteristics of USA100 decreased from 27.9% (152/545) to 12.6% (17/135), while the percent with CA-MRSA (USA300) characteristics increased from 53.2% (290/545) to 66.7% (90/135). The percent of infections that were invasive did not change significantly. Our data suggest that HA-MRSA infections, both by epidemiologic and microbiologic criteria, relative to CA-MRSA, decreased between 2004-5 and 2008 at UCMC.

David, Michael Z.; Cadilla, Adriana; Boyle-Vavra, Susan; Daum, Robert S.

2014-01-01

180

Replacement of HA-MRSA by CA-MRSA Infections at an Academic Medical Center in the Midwestern United States, 2004-5 to 2008.  

PubMed

We noted anecdotally that infections designated as health care-associated (HA-) MRSA by epidemiologic criteria seemed to be decreasing in incidence at the University of Chicago Medical Center (UCMC) after 2004. We compared MRSA patients seen at any site of clinical care at UCMC and the isolates that caused their infections in 2004-5 (n?=?545) with those in 2008 (n?=?135). The percent of patients with MRSA infections cultured > 2 days after hospital admission decreased from 19.5% in 2004-5 to 7.4% in 2008 (p?=?0.001). The percent in 2004-5 compared with 2008 who had a hospitalization (49.1% to 26.7%, p?=?0.001) or surgery (43.0% to 14.1%, p<0.001) in the previous year decreased. In 2008 a greater percent of patients was seen in the emergency department (23.1% vs. 39.3%) and a smaller percent both in intensive care units (15.6% vs. 6.7%) and in other inpatient units (40.7% vs. 32.6%) (p<0.001). The percent of patients with CA-MRSA infections by the CDC epidemiologic criteria increased from 36.5% in 2004-5 to 62.2% in 2008 (p<0.001). The percent of MRSA isolates sharing genetic characteristics of USA100 decreased from 27.9% (152/545) to 12.6% (17/135), while the percent with CA-MRSA (USA300) characteristics increased from 53.2% (290/545) to 66.7% (90/135). The percent of infections that were invasive did not change significantly. Our data suggest that HA-MRSA infections, both by epidemiologic and microbiologic criteria, relative to CA-MRSA, decreased between 2004-5 and 2008 at UCMC. PMID:24755631

David, Michael Z; Cadilla, Adriana; Boyle-Vavra, Susan; Daum, Robert S

2014-01-01

181

High-Density Livestock Production and Molecularly Characterized MRSA Infections in Pennsylvania  

PubMed Central

Background: European studies suggest that living near high-density livestock production increases the risk of sequence type (ST) 398 methicillin-resistant Staphylococcus aureus (MRSA) colonization. To our knowledge, no studies have evaluated associations between livestock production and human infection by other strain types. Objectives: We evaluated associations between MRSA molecular subgroups and high-density livestock production. Methods: We conducted a yearlong 2012 prospective study on a stratified random sample of patients with culture-confirmed MRSA infection; we oversampled patients from the Geisinger Health System with exposure to high-density livestock production in Pennsylvania. Isolates were characterized using S. aureus protein A (spa) typing and detection of Panton-Valentine leukocidin (PVL) and scn genes. We compared patients with one of two specific MRSA strains with patients with all other strains of MRSA isolates, using logistic regression that accounted for the sampling design, for two different exposure models: one based on the location of the animals (livestock model) and the other on crop field application of manure (crop field model). Results: Of 196 MRSA isolates, we identified 30 spa types, 47 PVL-negative and 15 scn-negative isolates, and no ST398 MRSA. Compared with quartiles 1–3 combined, the highest quartiles of swine livestock and dairy/veal crop field exposures were positively associated with community-onset-PVL-negative MRSA (CO-PVL-negative MRSA vs. all other MRSA), with adjusted odds ratios of 4.24 (95% CI: 1.60, 11.25) and 4.88 (95% CI: 1.40, 17.00), respectively. The association with CO-PVL-negative MRSA infection increased across quartiles of dairy/veal livestock exposure (trend p = 0.05). Conclusions: Our findings suggest that other MRSA strains, beyond ST398, may be involved in livestock-associated MRSA infection in the United States. Citation: Casey JA, Shopsin B, Cosgrove SE, Nachman KE, Curriero FC, Rose HR, Schwartz BS. 2014. High-density livestock production and molecularly characterized MRSA infections in Pennsylvania. Environ Health Perspect 122:464–470;?http://dx.doi.org/10.1289/ehp.1307370

Casey, Joan A.; Shopsin, Bo; Cosgrove, Sara E.; Nachman, Keeve E.; Curriero, Frank C.; Rose, Hannah R.

2014-01-01

182

High-density livestock production and molecularly characterized MRSA infections in pennsylvania.  

PubMed

Background: European studies suggest that living near high-density livestock production increases the risk of sequence type (ST) 398 methicillin-resistant Staphylococcus aureus (MRSA) colonization. To our knowledge, no studies have evaluated associations between livestock production and human infection by other strain types.Objectives: We evaluated associations between MRSA molecular subgroups and high-density livestock production.Methods: We conducted a yearlong 2012 prospective study on a stratified random sample of patients with culture-confirmed MRSA infection; we oversampled patients from the Geisinger Health System with exposure to high-density livestock production in Pennsylvania. Isolates were characterized using S. aureus protein A (spa) typing and detection of Panton-Valentine leukocidin (PVL) and scn genes. We compared patients with one of two specific MRSA strains with patients with all other strains of MRSA isolates, using logistic regression that accounted for the sampling design, for two different exposure models: one based on the location of the animals (livestock model) and the other on crop field application of manure (crop field model).Results: Of 196 MRSA isolates, we identified 30 spa types, 47 PVL-negative and 15 scn-negative isolates, and no ST398 MRSA. Compared with quartiles 1-3 combined, the highest quartiles of swine livestock and dairy/veal crop field exposures were positively associated with community-onset-PVL-negative MRSA (CO-PVL-negative MRSA vs. all other MRSA), with adjusted odds ratios of 4.24 (95% CI: 1.60, 11.25) and 4.88 (95% CI: 1.40, 17.00), respectively. The association with CO-PVL-negative MRSA infection increased across quartiles of dairy/veal livestock exposure (trend p = 0.05).Conclusions: Our findings suggest that other MRSA strains, beyond ST398, may be involved in livestock-associated MRSA infection in the United States.Citation: Casey JA, Shopsin B, Cosgrove SE, Nachman KE, Curriero FC, Rose HR, Schwartz BS. 2014. High-density livestock production and molecularly characterized MRSA infections in Pennsylvania. Environ Health Perspect 122:464-470;?http://dx.doi.org/10.1289/ehp.1307370. PMID:24509131

Casey, Joan A; Shopsin, Bo; Cosgrove, Sara E; Nachman, Keeve E; Curriero, Frank C; Rose, Hannah R; Schwartz, Brian S

2014-05-01

183

The High Diversity of MRSA Clones Detected in a University Hospital in Istanbul  

PubMed Central

Background: To characterize the methicillin-resistant Staphylococcus aureus (MRSA) clones present in Istanbul, 102 MRSA isolates collected during a 5-year period at the Istanbul Medical Faculty Hospital were characterized using microarray analysis and phenotypic resistance profiles. Methods: Resistance to methicillin was detected with a cefoxitin disk diffusion assay and confirmed with a MRSA-agar and MRSA detection kit. Antimicrobial susceptibility testing was performed by a disk diffusion assay and interpreted according to the 2012 guidelines of the Antibiogram Committee of the French Society for Microbiology. Decreased susceptibility to glycopeptides was confirmed using the population analysis profile-area under the curve (PAP-AUC) method. The presence of the mecA gene was detected by polymerase chain reaction. Bacterial DNA was extracted according to the manufacturer's recommended protocol using commercial extraction kits. Strains were extensively characterized using the DNA microarray. Results: Isolates were grouped into six clonal complexes. The most frequently detected clone was the Vienna/Hungarian/Brazilian clone (ST239-MRSA-III), which accounted for 53.9% of the isolates. These isolates were resistant to multiple antibiotics, particularly penicillin, tetracycline, rifampicin, kanamycin, tobramycin, gentamicin, levofloxacin, erythromycin, lincomycin and fosfomycin. Furthermore, three isolates were detected by population analysis profile as heterogeneous vancomycin-intermediate S. aureus (hVISA). The UK-EMRSA-15 clone (ST22-MRSA-IV PVL negative) was detected in 9.8% of the isolates and was mainly susceptible to all anti-staphylococcal antibiotics. Seven isolates (6.9%) were positive for PVL genes and were assigned to the CC80-MRSA-IV clone (European CA-MRSA clone, three isolates), ST8-MRSA-IV clone (USA300 clone, two isolates, one ACME-positive) or ST22-MRSA-IV clone (“Regensburg EMRSA” clone, two isolates). All other clones were detected in one to six isolates and corresponded to well-known clones (e.g., Pediatric clone, Dublin EMRSA clone, WA MRSA-54/63, WA MRSA-1/57). Conclusions: This work highlighted both the high prevalence of ST239-MRSA-III clone and the large diversity of the other MRSA clones detected in a university hospital in Istanbul.

Oksuz, Lutfiye; Dupieux, Celine; Tristan, Anne; Bes, Michele; Etienne, Jerome; Gurler, Nezahat

2013-01-01

184

Limited effectiveness of chlorhexidine based hand disinfectants against methicillin-resistant Staphylococcus aureus (MRSA).  

PubMed

Hand disinfectants containing chlorhexidine are thought to be less bactericidal against methicillin-resistant Staphylococcus aureus (MRSA) than methicillin-susceptible Staphylococcus aureus (MSSA). We report an in vitro comparison between three distinct MRSA strains and three MSSA strains. The bactericidal efficacy of chlorhexidine digluconate, 'Hibiscrub' and 'Hibisol' against Staphylococcus aureus was determined in a quantitative suspension test. Logarithmic reduction factors (RF) were calculated for each of six parallel experiments. Chlorhexidine digluconate and 'Hibisol' showed RF > 5 at most concentrations and reaction times but 'Hibiscrub' did not. MRSA was found to be significantly less susceptible than MSSA to chlorhexidine digluconate, 'Hibiscrub' and 'Hibisol' (P < 0.05; two-tailed t-test for independent samples). 'Hibisol' was significantly more effective against MRSA than 'Hibiscrub' (P < 0.05). Hand disinfectants containing both alcohol and chlorhexidine (e.g., 'Hibisol') are more effective against MRSA than scrubs based only on chlorhexidine ('Hibiscrub') and should be used in clinical practice. PMID:9602978

Kampf, G; Jarosch, R; Rüden, H

1998-04-01

185

Maternal Intake of Natto, a Japan's Traditional Fermented Soybean Food, during Pregnancy and the Risk of Eczema in Japanese Babies.  

PubMed

Background: There are reports that the maternal diet during pregnancy may affect development of babies' eczema. We sought to investigate the association between the maternal diet during pregnancy and the risk of eczema in infancy in Japan. Methods: A birth cohort was set up at 2 hospitals in Chiba city. Dietary habits concerning fish, butter, margarine, yogurt and natto during pregnancy was obtained from mothers just after delivery. The intake frequencies of these foods were classified into four groups: 1) daily, 2) 2-3 times a week, 3) once a week and 4) once a month or less. Diagnosis of eczema at 6 months of age was made by the presence of an itchy rash that persisted more than two months. Results: Valid data on 650 mother-baby pairs were obtained. No relationship between frequencies of the maternal intake of fish, margarine and yogurt during pregnancy and the onset rate of the babies' eczema were observed. For butter consumption, the incidence of babies' eczema was significantly higher in the group with daily intake than in those with an intake 2-3 times a week or less (p = 0.044). For natto, incidence of babies' eczema was significantly lower in the group with everyday intake than those eating it 2-3 times a week or less (p = 0.020). Conclusions: High frequency intake of natto during pregnancy possibly reduces the incidence of eczema in children at 6 months of age. PMID:24759553

Ozawa, Naoko; Shimojo, Naoki; Suzuki, Yoichi; Ochiai, Shingo; Nakano, Taiji; Morita, Yoshinori; Inoue, Yuzaburo; Arima, Takayasu; Suzuki, Shuichi; Kohno, Yoichi

2014-06-01

186

Goeckerman therapy for the treatment of eczema: a practical guide and review of efficacy.  

PubMed

The Goeckerman regimen, consisting of the application of crude coal tar combined with exposure to ultraviolet radiation, was formulated in 1925 for the treatment of psoriasis. While some centers have adapted the Goeckerman regimen for the treatment of eczema, there are no published reports of its efficacy in this condition. Here, we explain how the Goeckerman regimen has been modified for use in an eczema population at the University of California San Francisco (UCSF). We reviewed the treatment records of eczema patients treated with the modified Goeckerman regimen over a 6-year period at UCSF. We found that the Goeckerman regimen was effective in treating patients with severe baseline disease, inducing a mean remission period of 7.2 months. The treatment was tolerated well with mild folliculitis and occasional ultraviolet B phototoxicity noted as the only adverse reactions. Since the use of Goeckerman as a treatment for severe eczema is both effective and safe, it should be considered an excellent alternative or adjunct to the systemic therapies currently being used. PMID:21797807

Dennis, Madison; Bhutani, Tina; Koo, John; Liao, Wilson

2013-02-01

187

Eczematous reactions to food in atopic eczema: position paper of the EAACI and GA2LEN  

Microsoft Academic Search

Food allergy and atopic eczema (AE) may occur in the same patient. Besides typical immediate types of allergic reactions (i.e. noneczematous reactions) which are observed in patients suffering from AE, it is clear that foods, such as cows milk and hens eggs, can directly provoke flares of AE, particularly in sensitized infants. In general, inhaled allergens and pollen-related foods are

T. Werfel; B. Ballmer-Weber; P. A. Eigenmann; B. Niggemann; F. Ranc; K. Turjanmaa; M. Worm

188

Effect of Gentian Violet, Corticosteroid and Tar Preparations in Staphylococcus-aureus-Colonized Atopic Eczema  

Microsoft Academic Search

Background: In atopic eczema (AE), skin colonization with Staphylococcus aureus plays a possible role in the pathophysiology of the disease. Methods: Thirty-eight patients with AE were screened for their cutaneous colonization with S. aureus. The antibacterial and clinical efficacy of topical therapy with the antiseptic dye gentian violet, a potent glucocorticosteroid or a tar solution (liquor carbonis detergens) was evaluated

Knut Brockow; Petra Grabenhorst; Dietrich Abeck; Bernd Traupe; Johannes Ring; Udo Hoppe; Florian Wolf

1999-01-01

189

Cupping Therapy May be Harmful for Eczema: A PubMed Search  

PubMed Central

Eczema is a common childhood atopic condition and treatment is with emollients, topical corticosteroids, and avoidance of possible triggers. S. aureus colonization is a common complication. As there is no immediate cure, many parents seek alternative therapies that claim unproven therapeutic efficacy. We report a girl with long history of treatment noncompliance. After practicing a long period of dietary avoidance and supplementation, the grandparents took her to an alternative medicine practitioner. Following cupping therapy and acupuncture, the child developed blistering and oozing over her back the next day, which rapidly evolved to two large irregular-edge deep ulcers. She was treated with intravenous antibiotics and received multidisciplinary supportive intervention. Using search words of??“cupping,” “eczema,” and “atopic dermatitis,” only two reports were found on PubMed. Therapeutic efficacy was claimed but not scientifically documented in these reports. Childhood eczema is an eminently treatable atopic disease. Extreme alternative therapy seems not to be efficacious and may even be associated with serious undesirable sequelae. Physicians should be aware of various alternative treatment modalities and be prepared to offer evidence-based advice to the patients with eczema and their families.

Hon, Kam Lun E.; Luk, David Chi Kong; Leong, Kin Fon; Leung, Alexander K. C.

2013-01-01

190

RE: Japanese Combination Formula for Treatment of Eczema: A Clinical Study  

Microsoft Academic Search

Atopic dermatitis (eczema) is an immune-mediated dermatological condition characterized by severe and prolonged itching and rough, red patches of skin. Rash typically occurs on the face, neck, upper trunk, wrists, hands, knees, and elbows. It may form weeping, crusting lesions, which can become infected. Patients with atopic dermatitis may have difficulty sleeping due to the discomfort caused by the rash

Shari Henson; Brenda Milot; ELS John Neustadt; Heather S Oliff; Marissa Oppel; Cathleen Rapp; Steven Foster; Roberta Lee; Kathleen Coyne

191

A randomised study of "wet wraps" versus conventional treatment for atopic eczema  

PubMed Central

Aims To compare two treatments in common usage for children with atopic eczema: “wet wrap” bandages versus conventional topically applied ointments. Methods A total of 50 children (age 4–27?months) with moderate to severe eczema were randomised to one or other treatment. Two research nurses supervised the study. The first gave advice and support, and the second, blinded to the treatment modality being used, scored the change in eczema severity over a period of four weeks using the SCORAD eczema severity scale. Results Both treatments gave a benefit in overall SCORAD scores (mean change for wet wrap group was 53 to 24; for the conventional group, 41 to 17). There was no significant difference between the two groups in terms of overall improvement at four weeks or in the timescale of improvements. The amount of topical of topical steroid used was similar in both groups. The wet wrap group suffered significantly more skin infections requiring antibiotics. Carers reported that wet wraps were less easy to apply than conventional treatment.

Hindley, D; Galloway, G; Murray, J; Gardener, L

2006-01-01

192

Role of Virechana Karma in cure and prevention of recurrence of Vicharchika (Eczema)  

PubMed Central

Mandip and Chandola reported that administration of Rasayana (Guduchi and Bhringaraja) after Koshtha Shuddhi with Aragvadha Hima and simultaneous giving of Shirishadi decoction orally and applying of Snuhyadi Lepa externally provided complete remission to 22.6% patients of Vicharchika (Eczema) and checked the recurrences of the disease in the 89.5% patients. As in this group, cure rate was not up to the expectation; therefore, it was thought desirable to see whether performing of Virechana Karma instead of Koshtha Shuddhi prior to the administration of the above drugs enhances the cure rate for the Vicharchika (Eczema) patients. For the present study, 39 patients of Vicharchika (Eczema) were registered, of which 32 patients completed the full course of the treatment. These patients were given Virechana after preparing with the proper internal Snehana, Abhyanga, and Svedana as per classical method. After the Samsarjana Krama, they were administered the Shirishadi decoction and Guduchi-Bhringraja Rasayana powder orally with simultaneous local application of Snuhyadi Lepa on the eczematous lesions. The results of this study showed that when Virechana Karma was performed prior to the administration of Guduchi-Bhringaraja Rasayana and Shirishadi decoction orally and SnuhyadiLepa externally, it not only increased the cure rate to 81.3% in the patients of Vicharchika (Eczema) but also checked the recurrences to great extent as only negligible number of the patients reported the recurrence.

Kaur, Mandip; Chandola, Harimohan

2012-01-01

193

Clinical Management of Atopic Eczema with Pimecrolimus Cream 1% (Elidel®) in Paediatric Patients  

Microsoft Academic Search

Atopic eczema is predominantly a disease of children and infants, and is often a significant burden for both the sufferer and the family. Pimecrolimus cream 1% (Elidel®) is a topical calcineurin inhibitor that has been developed for the treatment of inflammatory skin diseases. When applied twice daily, pimecrolimus has been shown to be effective and well tolerated in paediatric patients

Lawrence F. Eichenfield; Diamant Thaci; Yves de Prost; Lluis Puig; Carle Paul

2007-01-01

194

Relationship of patch test positivity in a general versus an eczema population.  

PubMed

Using previously generated data from multicenter studies European Environmental and Contact Dermatitis Research Group (EECDRG) and North American Contact Dermatitis Group (NACDG), we compare patch test positivity of random sample and eczema populations, attempting to ascertain how one might extrapolate frequency from an eczema group to a general population. We included population-based mathematical estimates for patch test reaction in the general population using the Multinational MONItoring of trends and determinants in Cardiovascular disease MONICA and Clinical Epidemiology and Drug-Utilization Research (CE-DUR) systems. Data analysis provides a ratio of eczema population:random sample population for each allergen and an overall ratio of all allergens 5:1 for actual data and 6:1 for population-based estimates (according to the MONICA and CE-DUR systems). If the positivity rate were the same in each population, the ratio would approximate 1. The individual allergen ratios ranged from formaldehyde at 11.6 to parabens at 1.0, with respect to the NACDG. Some differences may be explained by exposure (neomycin) being greater in patients than in random population. Materials of ubiquitous exposure - i.e. fragrance mix and nickel - had ratios closer to 1. Taken together, data obtained in eczema patients may be viewed as part of a complex biology and may eventually be of use in aiding validation of predictive dermatotoxilogic assays and in public health assessments. PMID:17295685

Mirshahpanah, Parham; Maibach, Howard I

2007-03-01

195

International patterns of tuberculosis and the prevalence of symptoms of asthma, rhinitis, and eczema  

Microsoft Academic Search

BACKGROUNDAn ecological analysis was conducted of the relationship between tuberculosis notification rates and the prevalence of symptoms of asthma, allergic rhinoconjunctivitis, and atopic eczema in 85 centres from 23 countries in which standardised data are available. These essentially comprised countries in Europe as well as the USA, Canada, Australia, and New Zealand.METHODSTuberculosis notification rates were obtained from the World Health

Erika von Mutius; Neil Pearce; Richard Beasley; Soo Cheng; Ondine von Ehrenstein; Bengt Björkstén; Stephan Weiland

2000-01-01

196

Hand Eczema in Swedish Adults – Changes in Prevalence between 1983 and 1996  

Microsoft Academic Search

Hand eczema is the most frequent occupational skin disease. Our aim was to study changes in its prevalence in Swedish adults. Cross-sectional studies were performed in 1983 and 1996. Random samples from the population of Gothenburg, Sweden, aged 20–65 y, were drawn from the population register. Data were collected with a postal questionnaire, which was identical in the two studies.

Birgitta Meding; Bengt Järvholm

2002-01-01

197

Chromosome 11q13.5 variant associated with childhood eczema: An effect supplementary to filaggrin mutations  

PubMed Central

Background Atopic eczema is a common inflammatory skin disease with multifactorial etiology. The genetic basis is incompletely understood; however, loss of function mutations in the filaggrin gene (FLG) are the most significant and widely replicated genetic risk factor reported to date. The first genome-wide association study in atopic eczema recently identified 2 novel genetic variants in association with eczema susceptibility: a single nucleotide polymorphism on chromosome 11q13.5 (rs7927894) and a single nucleotide polymorphism (rs877776) within the gene encoding hornerin on chromosome 1q21. Objective To test the association of these 2 novel variants with pediatric eczema and to investigate their interaction with FLG null mutations. Methods Case-control study to investigate the association of rs7927894, rs877776 and the 4 most prevalent FLG null mutations with moderate-severe eczema in 511 Irish pediatric cases and 1000 Irish controls. Comprehensive testing for interaction between each of the loci was also performed. Results The association between rs7927894 and atopic eczema was replicated in this population (P = .0025, ?2 test; odds ratio, 1.27; 95% CI, 1.09-1.49). The 4 most common FLG null variants were strongly associated with atopic eczema (P = 1.26 × 10?50; combined odds ratio, 5.81; 95% CI, 4.51-7.49). Interestingly, the rs7927894 association was independent of the well-established FLG risk alleles and may be multiplicative in its effect. There was no significant association between rs877776 and pediatric eczema in this study. Conclusion Single nucleotide polymorphism rs7927894 appears to mark a genuine eczema susceptibility locus that will require further elucidation through fine mapping and functional analysis.

O'Regan, Grainne M.; Campbell, Linda E.; Cordell, Heather J.; Irvine, Alan D.; McLean, W.H. Irwin; Brown, Sara J.

2010-01-01

198

The influence of cultural and educational factors on the validity of symptom and diagnosis questions for atopic eczema.  

PubMed

Valid questions for atopic eczema are necessary to identify risk factors in epidemiological studies. We have examined the influence of cultural and educational factors on the validity of some questions on atopic eczema used in the International Study of Asthma and Allergies in Childhood by using data from a cross-sectional study on 1511 children aged 6 years from East and West Germany. We tested three questions in relation to a point prevalence of atopic eczema as recorded by a dermatologist: (i) has a physician ever diagnosed eczema in your child? (ii) Has your child ever had an itchy rash which came and went for at least 6 months? (iii) Has your child ever had 'neurodermatitis' (atopic eczema, endogenous eczema)? The point prevalence of atopic eczema on the day of investigation was 11.1% (134 of 1217). According to the questionnaire, 15.7% of the children had had physician-diagnosed eczema, 14.1% had had neurodermatitis and 11.3% had had an itchy rash for > 6 months. Fifty-one per cent of parents who had a child with atopic eczema on the day of investigation said that their child had had an itchy rash which came and went for at least 6 months. This sensitivity value is less than that found in another community survey conducted in the U.K., suggesting that the German wording of the question seems to mean something more severe to the parents than the English one. The education of the parents had an influence on the validity of the three questions: parents with < 10 years of schooling often answered symptom and diagnosis questions less positively. Parents with academic degrees, contrary to expectation, did not answer most precisely, this being especially true for the symptom questions. The association between symptom questions and clinical diagnosis was higher in West than in East Germany. We compared lifetime eczema symptoms and diagnosis with a point prevalence clinical diagnosis. In the absence of knowledge of how extraneous factors measured in this paper can affect diseases chronicity, it is difficult to say with certainty that such factors affect the validity of symptom and diagnosis questions on atopic eczema. Our study suggests that more studies are needed to examine the influence of social class, education and location on the validity of symptom questionnaires for atopic eczema. Until then, we recommend that information about such variables should be gathered routinely. PMID:9990368

Krämer, U; Schäfer, T; Behrendt, H; Ring, J

1998-12-01

199

Hospital-associated methicillin-resistant Staphylococcus aureus (HA-MRSA) in Italy  

PubMed Central

The aim of our study was to trace the dynamic changes of hospital-associated methicillin-resistant Staphylococcus aureus (HA-MRSA) lineages in Italy, comparing the genotypic backgrounds of contemporary isolates over a period of 17 years, with those of a sample of early MRSA strains from 1980. In total, 301 non-repetitive MRSA clinical isolates, recovered from 19 Italian hospitals between 1990 and 2007 were selected and analyzed for their antibiotic resistance, typed by PFGE and SCCmec, grouped into clonal-types and further characterized using Multi Locus Sequence Typing (MLST). A sample of fifteen early MRSA strains from 1980 was also used for comparison. The most interesting feature was the recent increase of ST228-MRSA-I (formerly the Italian clone; PFGE E) over the period 2000–2007 (57%), when compared to the period 1990–1999 (29%), and its stability to date, associated with a decrease of the highly epidemic ST247-MRSA-IA (formerly the Iberian clone; PFGE A), (23% from 1990 to 1999, 6% from 2000 to 2007). ST1-MRSA-I (1 out of 2 strains carrying ccrA2B2), ST8-MRSA-I (4 strains), ST15-MRSA-I (1 out of 4 carrying ccrA2B2) and ST30-MRSA-I (2 out of 5 carrying no ccrAB-types and ccrC) were the predominant earliest STs among the MRSA strains in 1980. A temporal shift in the susceptibility levels to glycopeptides was observed: strains with vancomycin MIC of ? 2 mg/L increased from 19.4% to 35.5%. In conclusion, we describe the alternation of MRSA clones that occurred in hospitals from 1990 to 2007 and the increase of the glycopeptide MIC levels, reflecting a worldwide trend. We document the detection of ST1, ST8, ST15 and ST30 in the 1980 isolates; we hypothesize their possible latency and their appearance as the current CA-MRSA clones.

Campanile, Floriana; Bongiorno, Dafne; Borbone, Sonia; Stefani, Stefania

2009-01-01

200

Climatic factors are associated with childhood eczema prevalence in the United States.  

PubMed

Atopic dermatitis (AD, also known as atopic eczema) is driven by a complex relationship between genetic predisposition and environmental exposures. We sought to determine the impact of specific climatic factors on the prevalence of AD in the United states. We used a merged analysis of the 2007 National Survey of Children's Health (NSCH) from a representative sample of 91,642 children aged 0-17 years and the 2006-2007 National Climate Data Center and Weather Service measurements of relative humidity (%), indoor heating degree days (HDD), clear-sky UV indices, ozone levels, and outdoor air temperature. As a proxy for AD, we used an affirmative response to the NSCH survey question asking whether the participant's child has been given a doctor diagnosis of "eczema or any other kind of skin allergy" in the previous 12 months. In multivariate models controlling for sex, race/ethnicity, age, and household income, eczema prevalence was significantly lower with the highest-quartile mean annual relative humidity (logistic regression, adjusted odds ratio (95% confidence interval)=0.82 (0.71-0.96), P=0.01) and issued UV index (0.73 (0.64-0.84), P<0.0001), and with two other factors associated with increased UV exposure. Eczema prevalence was decreased with the highest-quartile air temperature (0.80 (0.70-0.92), P=0.002) but increased with third-quartile mean annual HDD (1.26 (1.11-1.43), P=0.0003). This study provides evidence of climate influences on the US prevalence of childhood eczema. PMID:23334343

Silverberg, Jonathan I; Hanifin, Jon; Simpson, Eric L

2013-07-01

201

Quinoline and cyanine dyes--putative anti-MRSA drugs.  

PubMed

One way in which drug-resistant bacteria may be attacked is to screen new series of candidate compounds. Quaternary quinoline compounds and dyes were studied by Carl Browning (1887-1972) and Julius Cohen (1859-1935). A remarkable part of Browning and Cohen's work was the early development of structure-activity relationships for their series of compounds. Thus cationic species were found generally to be more effective antibacterials than neutrals or anionics, and the testing of partial or deconstructed active molecules was also carried out. Much of this work underpinned the fuller understanding of e.g. aminoacridine action developed by Adrien Albert (1907-1989), himself also a collaborator of Browning. Analysis of the activity of a range of compounds developed by Browning and Cohen suggests that these might again be examined as topical antimicrobials in the fight against methicillin-resistant S. aureus (MRSA) and other resistant bacteria. PMID:14602365

Wainwright, Mark; Kristiansen, Jette E

2003-11-01

202

Laboratory Maintenance of Methicillin-Resistant Staphylococcus aureus (MRSA)  

PubMed Central

Staphylococcus aureus is an important bacterial pathogen in the hospital and community settings, especially Staphylococcus aureus clones that exhibit methicillin-resistance (MRSA). Many strains of S. aureus are utilized in the laboratory, underscoring the genetic differences inherent in clinical isolates. S. aureus grows quickly at 37°C with aeration in rich media (e.g. BHI) and exhibits a preference for glycolytic carbon sources. Furthermore, S. aureus has a gold pigmentation, exhibits ?-hemolysis, and is catalase and coagulase positive. The four basic laboratory protocols presented in this unit describe how to culture S. aureus on liquid and solid media, how to identify S. aureus strains as methicillin resistant, and how to generate a freezer stock of S. aureus for long-term storage.

Vitko, Nicholas P.; Richardson, Anthony R.

2014-01-01

203

Epidemiology and Outcome of Pneumonia Caused by Methicillin-Resistant Staphylococcus aureus (MRSA) in Canadian Hospitals  

PubMed Central

Background MRSA remains a leading cause of hospital-acquired (HAP) and healthcare-associated pneumonia (HCAP). We describe the epidemiology and outcome of MRSA pneumonia in Canadian hospitals, and identify factors contributing to mortality. Methods Prospective surveillance for MRSA pneumonia in adults was done for one year (2011) in 11 Canadian hospitals. Standard criteria for MRSA HAP, HCAP, ventilator-associated pneumonia (VAP), and community-acquired pneumonia (CAP) were used to identify cases. MRSA isolates underwent antimicrobial susceptibility testing, and were characterized by pulsed-field gel electrophoresis (PFGE) and Panton-Valentine leukocidin (PVL) gene detection. The primary outcome was all-cause mortality at 30 days. A multivariable analysis was done to examine the association between various host and microbial factors and mortality. Results A total of 161 patients with MRSA pneumonia were identified: 90 (56%) with HAP, 26 (16%) HCAP, and 45 (28%) CAP; 23 (14%) patients had VAP. The mean (± SD) incidence of MRSA HAP was 0.32 (± 0.26) per 10,000 patient-days, and of MRSA VAP was 0.30 (± 0.5) per 1,000 ventilator-days. The 30-day all-cause mortality was 28.0%. In multivariable analysis, variables associated with mortality were the presence of multiorgan failure (OR 8.1; 95% CI 2.5-26.0), and infection with an isolate with reduced susceptibility to vancomycin (OR 2.5, 95% CI 1.0-6.3). Conclusions MRSA pneumonia is associated with significant mortality. Severity of disease at presentation, and infection caused by an isolate with elevated MIC to vancomcyin are associated with increased mortality. Additional studies are required to better understand the impact of host and microbial variables on outcome.

Tadros, Manal; Williams, Victoria; Coleman, Brenda L.; McGeer, Allison J.; Haider, Shariq; Lee, Christine; Iacovides, Harris; Rubinstein, Ethan; John, Michael; Johnston, Lynn; McNeil, Shelly; Katz, Kevin; Laffin, Nancy; Suh, Kathryn N.; Powis, Jeff; Smith, Stephanie; Taylor, Geoff; Watt, Christine; Simor, Andrew E.

2013-01-01

204

Genome sequencing and molecular characterisation of Staphylococcus aureus ST772-MRSA-V, "Bengal Bay Clone"  

PubMed Central

Background The PVL-positive ST772-MRSA-V is an emerging community-associated (CA-) MRSA clone that has been named Bengal Bay Clone since most patients have epidemiological connections to the Indian subcontinent. It is found increasingly common in other areas of the world. Methods One isolate of ST772-MRSA-V was sequenced using the Illumina Genome Analyzer System. After initial assembling the multiple sequence contigs were analysed using different in-house annotation scripts. Results were compared to microarray hybridisation results of clinical isolates of ST772-MRSA-V, of related strains and to another ST772-MRSA-V genome sequence. Results According to MLST e-burst analysis, ST772-MRSA-V belongs to Clonal Complex (CC)1, differing from ST1 only in one MLST allele (pta-22). However, there are several additional differences including agr alleles (group II rather than III), capsule type (5 rather than 8), the presence of the egc enterotoxin gene cluster and of the enterotoxin homologue ORF CM14 as well as the absence of the enterotoxin H gene seh. Enterotoxin genes sec and sel are present. ST772-MRSA-V harbours the genes encoding enterotoxin A (sea) and PVL (lukS/F-PV). Both are located on the same prophage. Conclusions ST772-MRSA-V may have emerged from the same lineage as globally spread CC1 and CC5 strains. It has acquired a variety of virulence factors, and for a CA-MRSA strain it has an unusually high number of genes associated with antibiotic resistance.

2013-01-01

205

Silver resistance in MRSA isolated from wound and nasal sources in humans and animals.  

PubMed

Methicillin-resistant Staphylococcus aureus (MRSA) colonises skin, nasal passages and dermal wounds. Methods used to manage wounds infected and colonised with MRSA often include the use of topical antiseptics such as ionic silver and iodine. The objectives of this study were to determine the prevalence of silver-resistance (sil) genes in MRSA and methicillin-resistant coagulase-negative staphylococci (MR-CNS) isolated from wounds and nasal cavities of humans and animals, and also to determine the susceptibility of sil-positive and sil-negative MRSA isolates to a silver-containing Hydrofiber (SCH) wound dressing, on planktonic silE-positive and silE-negative MRSA. Polymerase chain reaction was used to determine the presence of three silver-resistance (sil) genes, silE, silP and silS in 33 MRSA and 8 methicillin-resistant staphylococci (MR-CNS). SilP and silS genes were absent in all isolates tested; however, two MRSA strains were found to contain the silE gene, together with one isolate of MR-CNS. Phenotypic resistance of the silE-positive strains and their susceptibility to the SCH dressing was evaluated using the zone of inhibition test on Mueller Hinton agar, and confocal laser microscopy using a live/dead fluorescent stain. Results confirmed that the SCH dressing was effective in killing all MRSA strains with and without the silE gene. First, this study showed that the prevalence of sil genes was low in the isolates investigated; and secondly, that the presence of a silver-resistance gene (silE) in MRSA and MR-CNS did not afford protection to the organism in the presence of a SCH wound dressing. The use of topical antiseptics in chronic wound care should be considered before the use of antibiotics that can result in their overuse and the risk of further resistance. PMID:19291113

Loh, Jia V; Percival, Steven L; Woods, Emma J; Williams, Nicola J; Cochrane, Christine A

2009-02-01

206

Virulence Strategies of the Dominant USA300 Lineage of Community Associated Methicillin Resistant Staphylococcus aureus (CA-MRSA)  

PubMed Central

Methicillin-Resistant Staphylococcus aureus (MRSA) poses a serious threat to worldwide health. Historically, MRSA clones have strictly been associated with hospital settings and most hospital-associated MRSA (HA-MRSA) disease resulted from a limited number of virulent clones. Recently, MRSA has spread into the community causing disease in otherwise healthy people with no discernible contact with healthcare environments. These community-associated (CA-MRSA) are phylogenetically distinct from traditional HA-MRSA clones and CA-MRSA strains seem to exhibit hyper virulence and more efficient host:host transmission. Consequently, CA-MRSA clones belonging to the USA300 lineage have become dominant sources of MRSA infections in North America. The rise of this successful USA300 lineage represents an important step in the evolution of emerging pathogens and a great deal of effort has been exerted to understand how these clones evolved. Here we review much of the recent literature aimed at illuminating the source of USA300 success and broadly categorize these findings into three main categories: newly acquired virulence genes, altered expression of common virulence determinants and alterations in protein sequence that increase fitness. We argue that none of these evolutionary events alone account for the success of USA300, but rather their combination may be responsible for the rise and spread of CA-MRSA.

Thurlow, Lance R.; Joshi, Gauri S.; Richardson, Anthony R.

2014-01-01

207

Comparison of the Xpert Methicillin-Resistant Staphylococcus aureus (MRSA) Assay, BD GeneOhm MRSA Assay, and Culture for Detection of Nasal and Cutaneous Groin Colonization by MRSA?  

PubMed Central

Detection of methicillin (meticillin)-resistant Staphylococcus aureus colonization was assessed using combined nose and groin swabs in two commercial PCR assays (the Xpert MRSA assay and the BD GeneOhm MRSA assay). Compared to routine culture, both had similar sensitivities (87.0% versus 84.8%, respectively) and specificities (93.8% versus 92.7%, respectively). Combined PCR assays provide a rapid and more-complete assessment of colonization at a cost similar to that of single-site analysis.

Kelley, P. G.; Grabsch, E. A.; Howden, B. P.; Gao, W.; Grayson, M. L.

2009-01-01

208

Overview of Reviews The prevention of eczema in infants and children: an overview of Cochrane and non-Cochrane reviews  

PubMed Central

Background Eczema is the most common inflammatory skin disease of childhood, characterized by an itchy red rash that usually involves the face and skin folds. There is currently no curative treatment for eczema, so the reduction of eczema incidence through disease prevention is a desirable goal. Potential interventions for preventing eczema include exclusive breastfeeding, hydrolysed protein formulas and soy formulas when bottle feeding, maternal antigen avoidance, omega oil supplementation, prebiotics and probiotics. Objectives This overview of reviews aims to present the current body of data from Cochrane and non-Cochrane reviews to provide the most up-to-date evidence on the efficacy and safety of interventions to prevent eczema in infants and children at different risk levels for developing allergic disease. Methods Our pool of Cochrane and non-Cochrane reviews came from the 2010 United Kingdom National Health Service (NHS) Evidence Skin Disorders Annual Evidence Updates Mapping Exercise on Atopic Eczema. This group used a comprehensive search strategy last conducted in August 2010 to identify all systematic reviews on eczema prevention. We identified all reviews that met our pre-specified inclusion criteria, and data were extracted, analysed, compiled into tables and synthesized using quantitative and qualitative methods. Main results Seven systematic reviews containing 39 relevant trials with 11 897 participants were included in this overview. Overall, there was no clear evidence that any of the main interventions reviewed reduced eczema incidence. In subgroup analyses of infants at high risk of allergic disease, an observational study found that exclusive breastfeeding for at least six months compared with introduction of solids at three to six months decreased the incidence of eczema by 60% (risk ratio (RR): 0.40; 95% confidence interval (CI): 0.21, 0.78), and a randomized controlled trial found that prebiotics compared with no prebiotics decreased incidence by 58% (RR: 0.42; 95% CI: 0.21, 0.84). However, each of these findings was based on the results of a single small trial, and no intervention reduced eczema incidence beyond the first two years of life. Although we pre-specified incidence of atopic eczema (i.e. eczema associated with immunoglobulin E (IgE) sensitization) as a primary outcome, data on whether participants diagnosed with eczema were truly atopic were largely lacking from systematic reviews. Similarly, data on atopy, measured using skin prick tests or specific IgE tests to allergens, were not reported in many reviews. No interventions were found to decrease atopy when reported. Adverse events data were generally lacking, but data from a trial of probiotics versus no probiotics showed significantly more spitting up in the first one (RR: 1.88; 95% CI: 1.03, 3.45) and two (RR: 1.69; 95% CI: 1.02, 2.80) months of life, but no overall increase in risk of gastrointestinal symptoms in the first year. Authors’ conclusions Although there is currently no clear evidence showing that any of the interventions examined in this overview prevent eczema in participants not selected for risk of allergic disease, there is some evidence that exclusive breastfeeding for at least six months and prebiotics might reduce eczema incidence in high-risk participants. However, these conclusions are based on limited evidence with methodological shortcomings. Future research on prevention of eczema is needed and should examine different types of hydrolysed formulas, prebiotics and probiotics, as well as enhancement of the skin barrier and other novel approaches in infants at different risk levels for developing allergic disease.

Foisy, Michelle; Boyle, Robert J.; Chalmers, Joanne R.; Simpson, Eric L.; Williams, Hywel C.

2012-01-01

209

Increased bronchial NO output in severe atopic eczema in children and adolescents.  

PubMed

Atopic children have an increased risk for asthma, which is preceded by bronchial inflammation. Exhaled nitric oxide (NO) measured at multiple exhalation flow rates can be used to assess alveolar NO concentration and bronchial NO flux, which reflect inflammation in lung periphery and central airways, respectively. Exhaled breath condensate is another non-invasive method to measure lung inflammation. The purpose of the present study was to find out if the severity of atopic eczema is associated with lung inflammation that can be observed with these non-invasive tests. We studied 81 patients (7-22 yr old) with atopic eczema and increased wheat-specific IgE (>or=0.4 kUA/l) and no diagnosis of asthma. Exhaled NO was measured at multiple exhalation flow rates, and bronchial NO flux and alveolar NO concentration were calculated. Cysteinyl-leukotriene concentrations were measured in exhaled breath condensate. The patients were divided into two groups according to the severity of atopic eczema. Patients with severe atopic eczema had enhanced bronchial NO output as compared with patients with mild eczema (2.1 +/- 0.5 vs. 0.9 +/- 0.1, p = 0.003). No statistically significant differences in alveolar NO concentrations were found between the groups. In the whole group of patients, the bronchial NO output correlated positively with serum eosinophil protein X (r(s) = 0.450, p < 0.001), serum eosinophil cationic protein (r(s) = 0.393, p < 0.001), serum total IgE (r(s) = 0.268, p = 0.016) and with urine eosinophil protein X (r(s) = 0.279, p = 0.012), but not with lung function. Alveolar NO concentration correlated positively with serum eosinophil protein X (r(s) = 0.444, p < 0.001) and with serum eosinophil cationic protein (r(s) = 0.362, p = 0.001). Measurable cysteinyl-leukotriene concentrations in exhaled breath condensate were found only in one-third of the patients, and there were no differences between the two groups. The results show that increased bronchial NO output is associated with eosinophilic inflammation and severe atopic eczema in patients without established asthma. PMID:18167156

Linkosalo, Laura; Lehtimäki, Lauri; Laitinen, Jukka; Kaila, Minna; Holm, Kati; Moilanen, Eeva

2008-08-01

210

High Prevalence of Superantigens Associated with the egc Locus in Staphylococcus aureus Isolates from Patients with Atopic Eczema  

Microsoft Academic Search

  \\u000a The present study was aimed at identifying a possible correlation between disease severity and colonization with superantigen-producing\\u000a Staphylococcus aureus strains in patients with atopic eczema. To this end, Staphylococcus aureus strains from 91 patients with atopic eczema were screened for various staphylococcal superantigens such as SEA, SEB, SEC,\\u000a SED, TSST1, the recently described enterotoxin gene cluster egc (which encodes

M. Mempel; G. Lina; M. Hojka; C. Schnopp; H.-P. Seidl; T. Schäfer; J. Ring; F. Vandenesch; D. Abeck

2003-01-01

211

The allergy gene: how a mutation in a skin protein revealed a link between eczema and asthma.  

PubMed

Ichthyosis vulgaris is a common genetic skin disorder characterized by dry, scaly skin. About 1% of the European population have the full presentation of ichthyosis vulgaris; up to 10% have a milder, subclinical form. Atopic eczema is the most common, inflammatory skin condition, affecting 20% of children. It is often accompanied by a number of other allergies, including atopic asthma. Atopic eczema is a complex trait, where predisposing genes in combination with environmental stimuli produce the disease. Recently, we reported the first loss-of-function genetic mutations in the filaggrin gene as the cause of ichthyosis vulgaris. We noted people with ichthyosis vulgaris also have atopic eczema (and vice versa) and that the filaggrin gene sits in a known atopic eczema susceptibility locus. We went on to confirm that filaggrin mutations, carried by up to 10% of the population, are the major genetic predisposing factor for atopic eczema and the various allergies associated with atopic eczema. Filaggrin is a highly abundant protein expressed in the uppermost part of the epidermis that is critical to the formation and hydration of the stratum corneum-the outermost dead cell layers responsible for the barrier function of the skin. Filaggrin deficiency leads to a "leaky" skin barrier that allows higher than normal water loss (explaining the dry, scaly skin), as well as allowing entry of allergens through the epidermis where they trigger inflammatory and allergic immune responses (atopic eczema and allergies). This work has placed the skin barrier at the center stage of eczema and allergy research and has kick-started new therapy development programs aimed at repairing or enhancing skin-barrier function as a means of treating or preventing these very common diseases. PMID:21399759

McLean, W H Irwin

2011-01-01

212

The Expression of BAFF, APRIL and TWEAK Is Altered in Eczema Skin but Not in the Circulation of Atopic and Seborrheic Eczema Patients  

PubMed Central

The TNF family cytokines BAFF (B-cell activating factor of the TNF family) and APRIL (a proliferation-inducing ligand) are crucial survival factors for B-cell development and activation. B-cell directed treatments have been shown to improve atopic eczema (AE), suggesting the involvement of these cytokines in the pathogenesis of AE. We therefore analyzed the expression of these TNF cytokines in AE, seborrheic eczema (SE) and healthy controls (HC). The serum/plasma concentration of BAFF, APRIL and a close TNF member TWEAK (TNF-like weak inducer of apoptosis) was measured by ELISA. The expression of these cytokines and their receptors in skin was analyzed by quantitative RT-PCR and immunofluorescence. Unlike other inflammatory diseases including autoimmune diseases and asthma, the circulating levels of BAFF, APRIL and TWEAK were not elevated in AE or SE patients compared with HCs and did not correlate with the disease severity or systemic IgE levels in AE patients. Interestingly, we found that the expression of these cytokines and their receptors was altered in positive atopy patch test reactions in AE patients (APT-AE) and in lesional skin of AE and SE patients. The expression of APRIL was decreased and the expression of BAFF was increased in eczema skin of AE and SE, which could contribute to a reduced negative regulatory input on B-cells. This was found to be more pronounced in APT-AE, the initiating acute stage of AE, which may result in dysregulation of over-activated B-cells. Furthermore, the expression levels of TWEAK and its receptor positively correlated to each other in SE lesions, but inversely correlated in AE lesions. These results shed light on potential pathogenic roles of these TNF factors in AE and SE, and pinpoint a potential of tailored treatments towards these factors in AE and SE.

Chen, Yunying; Lind Enoksson, Sara; Johansson, Catharina; Karlsson, Maria A.; Lundeberg, Lena; Nilsson, Gunnar

2011-01-01

213

Waves of trouble: MRSA strain dynamics and assessment of the impact of infection control.  

PubMed

There has been a sustained decline in bloodstream infections due to methicillin-resistant Staphylococcus aureus (MRSA) throughout the UK. The UK MRSA epidemic, which began in the 1990s, has been dominated by two epidemic MRSA (EMRSA) clones {EMRSA-15, of clonal complex (CC) 22 [sequence type (ST) 22], and EMRSA-16, of CC30 (ST36)}. It appears that both these clones followed a wave trajectory (initial expansion, relative stasis, then decline). Three recent studies have shown that ST36 has declined faster than ST22, a change that appears to have begun before the recent intensification of intensive control measures in the UK. The biological basis of infectious disease waves, including those of MRSA, is discussed, as are the implications of such waves for the assessment of the impact of infection control measures. PMID:21948966

Wyllie, David; Paul, John; Crook, Derrick

2011-12-01

214

Occupational eczema and asthma in a hairdresser caused by hair-bleaching products.  

PubMed

Occupational allergic contact eczema and asthma caused by bleaching agents is seen in hairdressers. Bleaching agents contain persulfate salts, which are known to induce immediate reactions such as rhinitis, asthma, contact urticaria, and anaphylaxis. The immunologic mechanism is not, however, fully understood. The specific inhalation challenge test is considered to be the gold standard for diagnosing occupational asthma and rhinitis. However, this test is not always accessible. Therefore, the diagnosis of occupational allergic asthma caused by persulfate salts is made by combining a clinical history, a diagnosis of asthma, and a positive skin prick test (SPT). Standardized methods for performing SPT with persulfate salts are warranted. A case of a young hairdresser with occupational asthma and hand eczema caused by persulfate salts is presented, and the procedure for performing the SPT with ammonium persulfate and potassium persulfate is described in detail. PMID:23169211

Hougaard, Majken G; Menné, Torkil; Søsted, Heidi

2012-01-01

215

Role of Raktamokshana by Jalaukavacharana and Siravedhana in the management of Vicharchika (Eczema)  

PubMed Central

Eczema is most common skin disease which has social impact. The clinical picture of Eczema resembles with Vicharchika—a skin problem mentioned in Ayurvedic literature with Kapha and Pitta morbidly/pathology. In classical text of Ayurveda, Acharyas emphasize the Shodhana therapy as the line of treatment at various places. Among these various Shodhana therapy, Raktamokshan is indicated specially because Rakta is mainly involved as Dushya in Samprapti Ghataka. In the present comparative study, Raktamokshana with two different methods were selected to find out which method is more appropriate for Raktamokshana in Vicharchika. In A group, Jalaukavacharana Karma with Jalauka (Hirudinea medicinalis) and in B group, Siravedhana Karma with Syringe as method of Raktamokshana was selected. Better result was found in A group. So, it is better to manage Vicharchika using Jalaukavacharana as method of Raktamokshana in place of Siravedhana.

Raval, Hiren N.; Thakar, A. B.

2012-01-01

216

Pediatricians' perspectives on the impact of MRSA in primary care: a qualitative study  

Microsoft Academic Search

BACKGROUND: The incidence of skin and soft-tissue infections (SSTIs) has rapidly increased among children in primary care settings since the emergence of community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA). Recent treatment recommendations emphasize CA-MRSA as the primary cause, performing incision and drainage (I&D) as the primary therapy, and not prescribing antibiotics for uncomplicated cases. It is unknown how this epidemic has impacted

Adam L Hersh; Michael D Cabana; Ralph Gonzales; Budd N Shenkin; Christine S Cho

2009-01-01

217

The cost of resistance: incremental cost of methicillin-resistant Staphylococcus aureus (MRSA) in German hospitals  

Microsoft Academic Search

Methicillin-resistant Staphylococcus aureus (MRSA) is a significant problem in many healthcare systems. In Germany, few data are available on its economic consequences\\u000a and, so far, no study has been performed using a large sample of real-life data from several hospitals. We present a retrospective\\u000a matched-pairs analysis of mortality, length of stay, and cost of MRSA patients based mainly on routine

Ansgar Resch; Michael Wilke; Christian Fink

2009-01-01

218

Efficacy and functionality of silver-coated textiles in patients with atopic eczema  

Microsoft Academic Search

Background Microbial skin colonization with Staphylococcus aureus is known to play an important role in atopic eczema (AE). Recently, an antibacterial effect of silver-coated textiles on S. aureus colonization has been demonstrated. Objectives To investigate clinical efficacy and functionality of silver-coated textiles in AE, a multicentre, double-blind, placebo-controlled trial was conducted. Patients\\/methods From November 2001 to August 2002, 68 consecutive

A Gauger; S Fischer; M Mempel; T Schaefer; R Foelster-Holst; D Abeck; J Ring

2006-01-01

219

Effect of Lactobacillus sakei supplementation in children with atopic eczema–dermatitis syndrome  

Microsoft Academic Search

Background: Probiotics have been suggested to be useful in children with atopic eczema-dermatitis syndrome (AEDS). Objective: To assess the clinical effect of Lactobacillus sakei supplementation in children with AEDS. Methods: In a double-blind, placebo-controlled trial, children aged 2 to 10 years with AEDS with a minimum SCORing of Atopic Dermatitis (SCORAD) score of 25 were randomized to receive either daily

Sung-Il Woo; Ji-Yoon Kim; Yong-Ju Lee; Nam-Shik Kim; Youn-Soo Hahn

2010-01-01

220

Susceptibility to asthma and eczema from mucosal and epidermal expression of distinctive genes  

Microsoft Academic Search

The past several years have seen an increase in the rate at which genes that are associated with allergic asthma and eczema\\u000a are discovered. This review examines genetic association, gene expression, and functional studies that have identified genes\\u000a that are expressed in the epithelial cells of the skin and lung and are involved in the pathogenesis of allergic asthma and

Graham Jones

2007-01-01

221

Treatment Following an Evidence-Based Algorithm versus Individualised Symptom-Oriented Treatment for Atopic Eczema  

Microsoft Academic Search

Background: Evidence-based treatment algorithms, successfully established for asthma, are missing for atopic eczema (AE). Objectives: To investigate whether treatment according to an evidence-based algorithm is an effective and applicable concept for the management of AE. Methods: Based on a systematic literature review, we developed an evidence-based severity-score-oriented treatment algorithm for AE and compared its effectiveness to that of an individualised

Jochen Schmitt; Michael Meurer; Uta Schwanebeck; Xina Grählert; Knut Schäkel

2008-01-01

222

MRSA: why have we got it and can we do anything about it?  

PubMed

MRSA, first identified in 1960, became a major cause of healthcare-associated infection with the emergence of epidemic strains EMRSA 15 and 16 in the 1990 s. MRSA bacteraemia surveillance in England showed a peak of 7700 in 2003-2004. A target was set to halve MRSA bacteraemias by 2008 backed by a central improvement programme for infection prevention and control. Healthcare-associated infection is a patient safety issue with joint responsibility between: clinicians responsible for patient care; managers responsible for the organisation of services; and the government/Department of Health responsible for national strategy, prioritisation and performance management, together with introducing a statutory Code of Practice. By 2011, the number of MRSA bacteraemias had reduced by 80% to 1481. The key drivers of improvement were management responsibility, enhanced surveillance, adherence to clinical protocols and care bundles for invasive procedures, hand hygiene and environmental cleaning, and improved isolation procedures and antibiotic stewardship. The target has been translated into an ongoing MRSA objective, and further control of MRSA is supported by a screening programme aimed at all relevant hospital admissions. Sustaining the reduction will depend upon joint responsibility between management maintaining compliance assurance with policies and individual clinicians keeping it as a priority in patient safety. PMID:22134591

Duerden, B I

2012-02-01

223

Evaluation of different methods to detect methicillin resistance in Staphylococcus aureus (MRSA).  

PubMed

The studies suggest that dogs living with human are potential risk of becoming MRSA carrier and increased risk of infections caused by MRSA. Phenotypic methods to detect methicillin resistance in Staphylococcus aureus (MRSA) are inadequate. The objective of the present study was to determine methicillin resistance in S. aureus by phenotypic susceptibility test (oxacillin disk diffusion, cefoxitin disk diffusion, oxacillin screen agar) and molecular methods (PCR as a gold standard) and the latex agglutination test for the detection of PBP2a and to evaluate the results of these tests for its sensitivity and specificity. A total of 100 swab samples were taken from muzzle site, in more contact with human, of dogs and MRSA were isolated. Oxacillin (1?g), cefoxitin (30?g) disk diffusion and oxacillin screen agar method were used. The isolates were also subjected to latex agglutination test for detection of PBP2a and PCR to detect mecA gene. By PCR 37% of isolates show the presence of mecA. Latex agglutination was found to be the most sensitive (97.29%) and cefoxitin disk diffusion to be the most specific (96.82%) tests for detection of MRSA. Our finding showed that combining oxacillin screen agar or cefoxitin disk diffusion with latex agglutination improves sensitivity and specificity to detect methicillin resistance S. aureus (MRSA) isolates. PMID:24656721

Alipour, Farzad; Ahmadi, Malahat; Javadi, Shahram

2014-01-01

224

MRSA: why have we got it and can we do anything about it?  

PubMed Central

MRSA, first identified in 1960, became a major cause of healthcare-associated infection with the emergence of epidemic strains EMRSA 15 and 16 in the 1990s. MRSA bacteraemia surveillance in England showed a peak of 7700 in 2003–2004. A target was set to halve MRSA bacteraemias by 2008 backed by a central improvement programme for infection prevention and control. Healthcare-associated infection is a patient safety issue with joint responsibility between: clinicians responsible for patient care; managers responsible for the organisation of services; and the government/Department of Health responsible for national strategy, prioritisation and performance management, together with introducing a statutory Code of Practice. By 2011, the number of MRSA bacteraemias had reduced by 80% to 1481. The key drivers of improvement were management responsibility, enhanced surveillance, adherence to clinical protocols and care bundles for invasive procedures, hand hygiene and environmental cleaning, and improved isolation procedures and antibiotic stewardship. The target has been translated into an ongoing MRSA objective, and further control of MRSA is supported by a screening programme aimed at all relevant hospital admissions. Sustaining the reduction will depend upon joint responsibility between management maintaining compliance assurance with policies and individual clinicians keeping it as a priority in patient safety.

Duerden, B I

2012-01-01

225

First description of PVL-positive methicillin-resistant Staphylococcus aureus (MRSA) in wild boar meat.  

PubMed

Staphylococcus aureus is an important food-borne pathogen due to the ability of enterotoxigenic strains to produce staphylococcal enterotoxins (SEs) in food. Methicillin-resistant S. aureus (MRSA) is also an important pathogen for humans, causing severe and hard to treat diseases in hospitals and in the community due to its multiresistance against antimicrobials. In particular, strains harbouring genes encoding for the Panton-Valentine leukocidin (PVL) toxin are of concern from a public health perspective as they are usually capable of causing severe skin and soft tissue infections (sSSTIs) and occasionally necrotizing pneumonia which is associated with high mortality. This is the first report on the detection of MRSA with genes encoding for PVL in wild boar meat. Among the 28 MRSA isolated from wild boar meat in the course of a national monitoring programme in Germany, seven harboured PVL-encoding genes. Six of the isolates were identical according to the results of spa-, MLST-, microarray- and PFGE-typing. They could be assigned to the epidemic MRSA clone USA300. Epidemiological investigations revealed that people handling the food were the most likely common source of contamination with these MRSA. These findings call again for suitable hygienic measures at all processing steps of the food production chain. The results of the study underline that monitoring along the food chain is essential to closely characterise the total burden of MRSA for public health. PMID:25016468

Kraushaar, Britta; Fetsch, Alexandra

2014-09-01

226

Ab Initio Design of Potent Anti-MRSA Peptides based on Database Filtering Technology  

PubMed Central

To meet the challenge of antibiotic resistance worldwide, a new generation of antimicrobials must be developed.1 This communication demonstrates ab initio design of potent peptides against methicillin-resistant Staphylococcus aureus (MRSA). Our idea is that the peptide is very likely to be active when most probable parameters are utilized in each step of the design. We derived the most probable parameters (e.g. amino acid composition, peptide hydrophobic content, and net charge) from the antimicrobial peptide database2 by developing a database filtering technology (DFT). Different from classic cationic antimicrobial peptides usually with high cationicity, DFTamP1, the first anti-MRSA peptide designed using this technology, is a short peptide with high hydrophobicity but low cationicity. Such a molecular design made the peptide highly potent. Indeed, the peptide caused bacterial surface damage and killed community-associated MRSA USA300 in 60 minutes. Structural determination of DFTamP1 by NMR spectroscopy revealed a broad hydrophobic surface, providing a basis for its potency against MRSA known to deploy positively charged moieties on the surface as a mechanism for resistance. A combination of our ab initio design with database screening3 led to yet another peptide with enhanced potency. Because of simple composition, short length, stability to proteases, and membrane targeting, the designed peptides are attractive leads for developing novel anti-MRSA therapeutics. Our database-derived design concept can be applied to the design of peptide mimicries to combat MRSA as well.

Mishra, Biswajit; Wang, Guangshun

2012-01-01

227

MRSA bacteraemia in patients on arrival in hospital: a cohort study in Oxfordshire 1997-2003  

PubMed Central

Objective To describe the incidence and determinants of methicillin resistant and methicillin sensitive Staphylococcus aureus (MRSA and MSSA) bacteraemia in patients presenting to acute hospitals. Design Anonymised record linkage study with information from hospital information systems and microbiology databases. Setting One teaching hospital and one district general hospital in Oxfordshire. Participants All patients admitted to a teaching hospital 1 April 1997 to 31 March 2003 and to a district general hospital 1 April 1999 to 31 March 2003. Main outcome measures Detection of MRSA and MSSA from blood cultures taken during the first two days of admission to hospital. Results In the teaching hospital, there were 479 patients with MSSA and 116 with MRSA bacteraemia admitted from the community. Among this group, which comprised 24% of all hospital MRSA cases, 31% (36 cases) of patients had been admitted to renal, oncology, or haematology services for intensive day case therapy. The 69% remaining were most commonly patients admitted as medical or surgical emergencies. At least 91% had been in hospital previously; the median time since discharge was 46 days. About half of cases were in patients in whom MRSA had not been isolated before. Similar epidemiology was observed in the district general hospital. Conclusion Diagnostic algorithms and policies on use of antibiotics need to reflect the fact that a quarter of hospital MRSA cases occur in patients who have previously been in hospital and are subsequently readmitted.

Wyllie, David H; Peto, Tim E A; Crook, Derrick

2005-01-01

228

Effects of Prenatal and Perinatal Exposure to Fine Air Pollutants and Maternal Fish Consumption on the Occurrence of Infantile Eczema  

PubMed Central

Background As there is a scarcity of evidence on potential hazards and preventive factors for infantile eczema operating in the prenatal period, the main goal of this study was to assess the role of prenatal exposure to fine particulate matter and environmental tobacco smoke (ETS) in the occurrence of infant eczema jointly with the possible modulating effect of maternal fish consumption. Methods The study sample consisted of 469 women enrolled during pregnancy, who gave birth to term babies (>36 weeks of gestation). Among all pregnant women recruited, personal measurements of fine particulate matter (PM2.5) were performed over 48 h in the second trimester of pregnancy. After delivery, every 3 months in the first year of the newborn's life, a detailed, standardized, face-to-face interview was administered to each mother, in the process of which a trained interviewer recorded any history of infantile eczema and data on potential environmental hazards. The estimated risk of eczema related to higher prenatal exposure to fine particulate matter (PM2.5 >53.0 ?g/m3) and postnatal ETS as well as the protective effect of maternal fish intake were adjusted for potential confounders in a multivariable logistic regression model. Results While the separate effects of higher prenatal PM2.5 and postnatal ETS exposure were not statistically significant, their joint effect appeared to have a significant influence on the occurrence of infantile eczema [odds ratio 2.39, 95% confidence interval (CI) 1.10–5.18]. With maternal fish intake of more than 205 g/week, the risk of eczema decreased by 43% (odds ratio 0.57, 95% CI 0.35–0.93). The incidence rate ratio (IRR) for eczema symptoms, estimated from the Poisson regression model, was increased with both higher exposure to prenatal PM2.5 and postnatal ETS (IRR 1.55, 95% CI 0.99–2.44) and in children of atopic mothers (IRR 1.35, 95% CI 1.04–1.75) but was lower in girls (IRR 0.78, 95% CI 0.61–1.00). The observed preventive effect of fish consumption on the frequency of eczema symptoms was consistent with the results of the logistic analysis (IRR 0.72, 95% CI 0.52–0.99). Conclusions The findings indicate that higher prenatal exposure to fine particulate matter combined with postnatal exposure to ETS may increase the risk of infant eczema, while maternal fish intake during pregnancy may reduce the risk of infantile eczema.

Jedrychowski, Wieslaw; Perera, Frederica; Maugeri, Umberto; Mrozek-Budzyn, Dorota; Miller, Rachel L.; Flak, Elzbieta; Mroz, Elzbieta; Jacek, Ryszard; Spengler, John D.

2011-01-01

229

Predicting the virulence of MRSA from its genome sequence  

PubMed Central

Microbial virulence is a complex and often multifactorial phenotype, intricately linked to a pathogen’s evolutionary trajectory. Toxicity, the ability to destroy host cell membranes, and adhesion, the ability to adhere to human tissues, are the major virulence factors of many bacterial pathogens, including Staphylococcus aureus. Here, we assayed the toxicity and adhesiveness of 90 MRSA (methicillin resistant S. aureus) isolates and found that while there was remarkably little variation in adhesion, toxicity varied by over an order of magnitude between isolates, suggesting different evolutionary selection pressures acting on these two traits. We performed a genome-wide association study (GWAS) and identified a large number of loci, as well as a putative network of epistatically interacting loci, that significantly associated with toxicity. Despite this apparent complexity in toxicity regulation, a predictive model based on a set of significant single nucleotide polymorphisms (SNPs) and insertion and deletions events (indels) showed a high degree of accuracy in predicting an isolate’s toxicity solely from the genetic signature at these sites. Our results thus highlight the potential of using sequence data to determine clinically relevant parameters and have further implications for understanding the microbial virulence of this opportunistic pathogen.

Laabei, Maisem; Recker, Mario; Rudkin, Justine K.; Aldeljawi, Mona; Gulay, Zeynep; Sloan, Tim J.; Williams, Paul; Endres, Jennifer L.; Bayles, Kenneth W.; Fey, Paul D.; Yajjala, Vijaya Kumar; Widhelm, Todd; Hawkins, Erica; Lewis, Katie; Parfett, Sara; Scowen, Lucy; Peacock, Sharon J.; Holden, Matthew; Wilson, Daniel; Read, Timothy D.; van den Elsen, Jean; Priest, Nicholas K.; Feil, Edward J.; Hurst, Laurence D.; Josefsson, Elisabet; Massey, Ruth C.

2014-01-01

230

Predicting the virulence of MRSA from its genome sequence.  

PubMed

Microbial virulence is a complex and often multifactorial phenotype, intricately linked to a pathogen's evolutionary trajectory. Toxicity, the ability to destroy host cell membranes, and adhesion, the ability to adhere to human tissues, are the major virulence factors of many bacterial pathogens, including Staphylococcus aureus. Here, we assayed the toxicity and adhesiveness of 90 MRSA (methicillin resistant S. aureus) isolates and found that while there was remarkably little variation in adhesion, toxicity varied by over an order of magnitude between isolates, suggesting different evolutionary selection pressures acting on these two traits. We performed a genome-wide association study (GWAS) and identified a large number of loci, as well as a putative network of epistatically interacting loci, that significantly associated with toxicity. Despite this apparent complexity in toxicity regulation, a predictive model based on a set of significant single nucleotide polymorphisms (SNPs) and insertion and deletions events (indels) showed a high degree of accuracy in predicting an isolate's toxicity solely from the genetic signature at these sites. Our results thus highlight the potential of using sequence data to determine clinically relevant parameters and have further implications for understanding the microbial virulence of this opportunistic pathogen. PMID:24717264

Laabei, Maisem; Recker, Mario; Rudkin, Justine K; Aldeljawi, Mona; Gulay, Zeynep; Sloan, Tim J; Williams, Paul; Endres, Jennifer L; Bayles, Kenneth W; Fey, Paul D; Yajjala, Vijaya Kumar; Widhelm, Todd; Hawkins, Erica; Lewis, Katie; Parfett, Sara; Scowen, Lucy; Peacock, Sharon J; Holden, Matthew; Wilson, Daniel; Read, Timothy D; van den Elsen, Jean; Priest, Nicholas K; Feil, Edward J; Hurst, Laurence D; Josefsson, Elisabet; Massey, Ruth C

2014-05-01

231

Vitamin D receptor activation improves allergen-triggered eczema in mice.  

PubMed

Atopic dermatitis (AD) is a common chronic inflammatory skin disease that has increased in prevalence over the last several decades in industrialized countries. AD is a multifactorial, heterogenous disease with a variety of defects in the immune system, in antimicrobial defense mechanisms and epidermal barrier integrity, which collectively contribute to the risk and severity of AD development. Vitamin D receptor (VDR) signaling has been shown to be important not only in the immune system but also in the skin and in particular keratinocytes to regulate skin homeostasis and epidermal barrier function. However, this work aimed to analyze the role and clinical efficiency of VDR activation by a VDR agonist without calcium-mobilizing activity in a mouse model of allergen-triggered eczema. We show that the systemic administration of the low-calcemic VDR agonist significantly improved the allergen-triggered eczema. Thereby, forkhead box P3 (Foxp3)-expressing regulatory T cells, revealed to have a role in AD, were selectively increased in the skin of VDR agonist-treated mice. Moreover, our results demonstrate a marked induction of skin barrier gene and antimicrobial peptide gene expression in skin lesions of VDR agonist-treated mice. Thus, our study provides evidence that systemic VDR agonist treatment may improve allergen-triggered eczema in vivo. PMID:21938012

Hartmann, Björn; Riedel, René; Jörss, Katharina; Loddenkemper, Christoph; Steinmeyer, Andreas; Zügel, Ulrich; Babina, Magda; Radbruch, Andreas; Worm, Margitta

2012-02-01

232

PATCH TESTING WITH DERMATOPHAGOIDES AND ITS CORRELATION WITH CHRONIC ECZEMA AND ATOPIC DERMATITIS  

PubMed Central

Background: Chronic eczema is commonly encountered in the Indian set up. So also is atopic dermatitis. House dust mites (Dermatophagoides) are implicated in various diseases like atopic dermatitis, asthma, and perennial rhinitis. It has also been proven that patch testing with Dermatophagoides pteronyssinus (DP) is important for detection of contact sensitization in chronic dermatitis. Aims: To study clinical characteristics of DP mix positive patients with regards to chronic dermatitis and atopic dermatitis. Methods: Dermatology outpatients presenting to the department of Skin and STD of Kasturba Medical College (KMC), with clinically diagnosed atopic dermatitis and chronic eczema were chosen for the study. Inclusion and exclusion criteria were well demarked. Eighty six randomly selected patients of dermatitis were subjected to patch testing with standard series and DP mix. Results: Of the 86, 50 (58%) showed positive reaction to DP mix. Among these positive patients, chronic dermatitis was seen in 42 (84%) with involvement of exposed parts in 37 (74%). Atopic dermatitis was seen in 19 patients (38%) from DP positive group whereas it was observed in 4 patients (17%) from the other group. Conclusion: Dermatophagoides mix positivity was statistically significant in chronic eczema as well as atopic dermatitis. Patch testing is an important tool to detect delayed type allergy to house dust mite.

Kapur, Chetna; Shenoi, Shrutakirthi D; Prabhu, Smitha S; Balachandran, C

2009-01-01

233

International patterns of tuberculosis and the prevalence of symptoms of asthma, rhinitis, and eczema  

PubMed Central

BACKGROUND—An ecological analysis was conducted of the relationship between tuberculosis notification rates and the prevalence of symptoms of asthma, allergic rhinoconjunctivitis, and atopic eczema in 85 centres from 23 countries in which standardised data are available. These essentially comprised countries in Europe as well as the USA, Canada, Australia, and New Zealand.?METHODS—Tuberculosis notification rates were obtained from the World Health Organization. Data on the prevalence of symptoms of asthma, rhinitis, and eczema in 235 477 children aged 13-14 years were based on the responses to the written and video questionnaires from the International Study of Asthma and Allergies in Childhood (ISAAC). The analysis was adjusted for gross national product (GNP) as an estimate of the level of affluence.?RESULTS—Tuberculosis notification rates were significantly inversely associated with the lifetime prevalence of wheeze and asthma and the 12 month period prevalence of wheeze at rest as assessed by the video questionnaire. An increase in the tuberculosis notification rates of 25 per 100 000 was associated with an absolute decrease in the prevalence of wheeze ever of 4.7%. Symptoms of allergic rhinoconjunctivitis in the past 12 months were inversely associated with tuberculosis notification rates, but there were no other significant associations with other ISAAC questions on allergic rhinoconjunctivitis or atopic eczema.?CONCLUSIONS—These findings are consistent with recent experimental evidence which suggests that exposure to Mycobacterium tuberculosis may reduce the risk of developing asthma.??

von Mutius, E.; Pearce, N.; Beasley, R.; Cheng, S.; von Ehrenstein, O.; Bjorksten, B.; Weiland, S.

2000-01-01

234

A Randomised Controlled Trial of Ion-Exchange Water Softeners for the Treatment of Eczema in Children  

PubMed Central

Background Epidemiological studies and anecdotal reports suggest a possible link between household use of hard water and atopic eczema. We sought to test whether installation of an ion-exchange water softener in the home can improve eczema in children. Methods and Findings This was an observer-blind randomised trial involving 336 children (aged 6 months to 16 years) with moderate/severe atopic eczema. All lived in hard water areas (?200 mg/l calcium carbonate). Participants were randomised to either installation of an ion-exchange water softener plus usual eczema care, or usual eczema care alone. The primary outcome was change in eczema severity (Six Area Six Sign Atopic Dermatitis Score, SASSAD) at 12 weeks, measured by research nurses who were blinded to treatment allocation. Analysis was based on the intent-to-treat population. Eczema severity improved for both groups during the trial. The mean change in SASSAD at 12 weeks was ?5.0 (20% improvement) for the water softener group and ?5.7 (22% improvement) for the usual care group (mean difference 0.66, 95% confidence interval ?1.37 to 2.69, p?=?0.53). No between-group differences were noted in the use of topical corticosteroids or calcineurin inhibitors. Conclusions Water softeners provided no additional benefit to usual care in this study population. Small but statistically significant differences were found in some secondary outcomes as reported by parents, but it is likely that such improvements were the result of response bias, since participants were aware of their treatment allocation. A detailed report for this trial is also available at http://www.hta.ac.uk. Trial registration Current Controlled Trials ISRCTN71423189 Please see later in the article for the Editors' Summary

Thomas, Kim S.; Dean, Tara; O'Leary, Caroline; Sach, Tracey H.; Koller, Karin; Frost, Anthony; Williams, Hywel C.

2011-01-01

235

Early exposure to solid foods and the development of eczema in children up to 4 years of age.  

PubMed

Early exposure to solid foods in infancy has been associated with the development of allergic diseases. However, scientific evidence for this is conflicting. The aim of this study was to examine the association between early exposure to solid foods in the infant's diet and the development of eczema up to 4 years of age. We conducted an etiologic case-control study nested in the PIPO cohort (Prospective Cohort on the Influence of Perinatal Factors on the Occurrence of Asthma and Allergies). In this cohort data on nutrition, environmental exposures and parent-reported eczema were collected prospectively starting from 5 months pregnancy by means of questionnaires administered during two home visits and semi-annual postal questionnaires. In addition, detailed information on the timing of introduction of solid foods at individual food item level was collected at 1 year of age. Adjusted odds ratios and 95% confidence intervals were computed using logistic regression analysis as a measure of association between eczema and the timing of exposure to solid foods. Early introduction (within the first 4 months) of solid foods was inversely associated with eczema up to 4 years of age (adj OR: 0.49; 95% CI: 0.32-0.74). Moreover, we found that early exposure to solid foods was associated with a reduced risk for eczema only among children with allergic parents (adj OR: 0.35; 95% CI: 0.20-0.63), whereas no significant effect was found among children with non-allergic parents (adj OR: 0.69; 95% CI: 0.37-1.29). The results of this study show that early exposure to solid foods is associated with less parent-reported eczema in children, particularly among children with allergic parents. Therefore, the current study does not support a delayed introduction of solid foods for the prevention of eczema in childhood. PMID:19573205

Sariachvili, Manana; Droste, Jos; Dom, Sandra; Wieringa, Marjan; Hagendorens, Margo; Stevens, Wim; van Sprundel, Marc; Desager, Kristien; Weyler, Joost

2010-02-01

236

Vancomycin-Impregnated polymethylmethacrylate beads for methicillin-resistant Staphylococcus aureus (MRSA) infection: Report of two cases  

Microsoft Academic Search

:   Two patients with methicillin-resistant Staphylococcus aureus (MRSA) infection were treated with vancomycin (VCM)-impregnated polymethylmethacrylate (PMMA) beads. One patient, who had\\u000a a history of polycystic kidney and diabetes mellitus, who was receiving hemodialysis due because of non-functional kidney,\\u000a underwent resection of an intermediate grade chondrosarcoma in the pelvis. MRSA infection developed and curettage of the lesion\\u000a was performed, but MRSA

Toshifumi Ozaki; Teruhito Yoshitaka; Toshiyuki Kunisada; Tomoyuki Dan'ura; Noriko Naito; Hajime Inoue

1998-01-01

237

Interplay of Filaggrin Loss-of-Function Variants, Allergic Sensitization, and Eczema in a Longitudinal Study Covering Infancy to 18 Years of Age  

PubMed Central

Background Immune specific genes as well as genes regulating the formation of skin barrier are major determinants for eczema manifestation. There is a debate as to whether allergic sensitization and filaggrin gene (FLG) variants lead to eczema or FLG variants and eczema increase the risk of allergic sensitization. To investigate the time-order between eczema and allergic sensitization with respect to FLG variants, data from a large prospective study covering infancy to late adolescence were analyzed. Methodology/Principal Findings Repeated measurements of eczema and allergic sensitization (documented by skin prick tests) at ages 1, 2, 4, 10, and 18 years were ascertained in the Isle of Wight birth cohort (n?=?1,456). Three transition periods were analyzed: age 1-or-2 to 4, 4 to 10, and 10 to 18 years. FLG variants were genotyped in 1,150 participants. Over the three transition periods, in temporal sequence analyses of initially eczema-free participants, the combined effect of FLG variants and allergic sensitization showed a 2.92-fold (95% CI: 1.47–5.77) increased risk ratio (RR) of eczema in subsequent examinations. This overall risk was more pronounced at a younger age (transition period 1-or-2 to 4, RR?=?6.47, 95% CI: 1.96–21.33). In contrast, FLG variants in combination with eczema showed a weaker, but significant, risk ratio for subsequent allergic sensitization only up to 10 years of age. Conclusions/Significance Taking the time order into account, this prospective study demonstrates for the first time, that a combination of FLG variants and allergic sensitization increased the risk of eczema in subsequent years. Also FLG variants interacted with eczema and increased the risk of subsequent allergic sensitization, which, was limited to the younger age. Hence, early restoration of defective skin barrier could prevent allergic sensitization and subsequently reduce the risk of eczema development.

Ziyab, Ali H.; Karmaus, Wilfried; Yousefi, Mitra; Ewart, Susan; Schauberger, Eric; Holloway, John W.; Zhang, Hongmei; Arshad, Syed Hasan

2012-01-01

238

Antibacterial activity of extracellular compounds produced by a Pseudomonas strain against methicillin-resistant Staphylococcus aureus (MRSA) strains  

PubMed Central

Background The emergence of multidrug-resistant bacteria is a world health problem. Staphylococcus aureus, including methicillin-resistant S. aureus (MRSA) strains, is one of the most important human pathogens associated with hospital and community-acquired infections. The aim of this work was to evaluate the antibacterial activity of a Pseudomonas aeruginosa-derived compound against MRSA strains. Methods Thirty clinical MRSA strains were isolated, and three standard MRSA strains were evaluated. The extracellular compounds were purified by vacuum liquid chromatography. Evaluation of antibacterial activity was performed by agar diffusion technique, determination of the minimal inhibitory concentration, curve of growth and viability and scanning electron microscopy. Interaction of an extracellular compound with silver nanoparticle was studied to evaluate antibacterial effect. Results The F3 (ethyl acetate) and F3d (dichloromethane- ethyl acetate) fractions demonstrated antibacterial activity against the MRSA strains. Phenazine-1-carboxamide was identified and purified from the F3d fraction and demonstrated slight antibacterial activity against MRSA, and synergic effect when combined with silver nanoparticles produced by Fusarium oxysporum. Organohalogen compound was purified from this fraction showing high antibacterial effect. Using scanning electron microscopy, we show that the F3d fraction caused morphological changes to the cell wall of the MRSA strains. Conclusions These results suggest that P. aeruginosa-produced compounds such as phenazines have inhibitory effects against MRSA and may be a good alternative treatment to control infections caused by MRSA.

2013-01-01

239

Influence of antimicrobial regimen on decreased in-hospital mortality of patients with MRSA bacteremia.  

PubMed

Methicillin-resistant Staphylococcus aureus (MRSA) is one of the most important causes of bacteremia. Recently, several epidemiological and microbiological changes have become evident in MRSA infections. The purposes of this study were to assess clinical characteristics of patients with MRSA bacteremia and microbiological changes in MRSA. We conducted a retrospective observational study on patients with MRSA bacteremia who were hospitalized between 2008 and 2011. We used univariate and multivariate analysis to evaluate the predictors associated with 30-day mortality. The 7-day and 30-day mortality rates were 12.0% and 25.3%, respectively. According to multivariate analysis, the independent predictors that associated with 30-day mortality were leukopenia, low serum albumin, high sequential organ failure assessment (SOFA) score, and quinolone use within 30 days. Compared to previous data (2003-2007), the SOFA score of the new data set remained unchanged, but in-hospital mortality decreased significantly. In particular, the mortality associated with use of vancomycin (VCM) was significantly lower. Although the minimum inhibitory concentration of VCM required to inhibit the growth of 90% of organisms (MIC90) had not changed, the trough value of VCM changed significantly; a VCM trough value of 10 or greater was significantly higher compared to previous data. Of the staphylococcal cassette chromosome mec (SCCmec) types, SCCmec II values decreased significantly, and SCCmec I and IV values increased significantly. Our results indicate that changes in VCM usage might contribute to decreased in-hospital mortality. PMID:24731430

Kaku, Norihito; Yanagihara, Katsunori; Morinaga, Yoshitomo; Yamada, Koichi; Harada, Yosuke; Migiyama, Yohei; Nagaoka, Kentaro; Matsuda, Jun-Ichi; Uno, Naoki; Hasegawa, Hiroo; Miyazaki, Taiga; Izumikawa, Koichi; Kakeya, Hiroshi; Yamamoto, Yoshihiro; Kohno, Shigeru

2014-06-01

240

Combination Therapy of Sophoraflavanone B against MRSA: In Vitro Synergy Testing  

PubMed Central

Sophoraflavanone B (SPF-B), a known prenylated flavonoid, was isolated from the roots of Desmodium caudatum. The aim of this study was to determine the antimicrobial synergism of SPF-B combined with antibiotics against methicillin-resistant Staphylococcus aureus (MRSA). MRSA, a multidrug-resistant pathogen, causes both hospital- and community-acquired infections worldwide. The antimicrobial activity of SPF-B was assessed by the broth microdilution method, checkerboard dilution test, and time-kill curve assay. The MIC of SPF-B for 7 strains of S. aureus ranges from 15.6 to 31.25??g/mL determined. In the checkerboard method, the combinations of SPF-B with antibiotics had a synergistic effect; SPF-B markedly reduced the MICs of the ?-lactam antibiotics: ampicillin (AMP) and oxacillin (OXI); aminoglycosides gentamicin (GET); quinolones ciprofloxacin (CIP) and norfloxacin (NOR) against MRSA. The time-kill curves assay showed that a combined SPF-B and selected antibiotics treatment reduced the bacterial counts below the lowest detectable limit after 24?h. These data suggest that the antibacterial activity of SPF-B against MRSA can be effectively increased through its combination with three groups of antibiotics (?-lactams, aminoglycosides, and quinolones). Our research can be a valuable and significant source for the development of a new antibacterial drug with low MRSA resistance.

Mun, Su-Hyun; Kang, Ok-Hwa; Joung, Dae-Ki; Kim, Sung-Bae; Seo, Yun-Soo; Choi, Jang-Gi; Lee, Young-Seob; Cha, Seon-Woo; Ahn, Young-Sup; Han, Sin-Hee; Kwon, Dong-Yeul

2013-01-01

241

Inhibition of WTA synthesis blocks the cooperative action of PBPs and sensitizes MRSA to ?-lactams.  

PubMed

Rising drug resistance is limiting treatment options for infections by methicillin-resistant Staphylococcus aureus (MRSA). Herein we provide new evidence that wall teichoic acid (WTA) biogenesis is a remarkable antibacterial target with the capacity to destabilize the cooperative action of penicillin-binding proteins (PBPs) that underlie ?-lactam resistance in MRSA. Deletion of gene tarO, encoding the first step of WTA synthesis, resulted in the restoration of sensitivity of MRSA to a unique profile of ?-lactam antibiotics with a known selectivity for penicillin binding protein 2 (PBP2). Of these, cefuroxime was used as a probe to screen for previously approved drugs with a cryptic capacity to potentiate its activity against MRSA. Ticlopidine, the antiplatelet drug Ticlid, strongly potentiated cefuroxime, and this synergy was abolished in strains lacking tarO. The combination was also effective in a Galleria mellonella model of infection. Using both genetic and biochemical strategies, we determined the molecular target of ticlopidine as the N-acetylglucosamine-1-phosphate transferase encoded in gene tarO and provide evidence that WTA biogenesis represents an Achilles heel supporting the cooperative function of PBP2 and PBP4 in creating highly cross-linked muropeptides in the peptidoglycan of S. aureus. This approach represents a new paradigm to tackle MRSA infection. PMID:23062620

Farha, Maya A; Leung, Alexander; Sewell, Edward W; D'Elia, Michael A; Allison, Sarah E; Ejim, Linda; Pereira, Pedro M; Pinho, Mariana G; Wright, Gerard D; Brown, Eric D

2013-01-18

242

[Is it necessary to know which workers are carriers of MRSA in contact with cancer patients?].  

PubMed

Our objective was to determine the prevalence of methicillin-resistant Staphylococcus aureus in workers who had direct contact with oncologic patients infected with MRSA and admitted to the intensive care unit of the Valencian Institute of Oncology. A study of prevalence of MRSA colonization of 62 workers was performed. Samples were taken from nose and pharynx in each of the workers. After 24 hours of incubation in Amies transport medium Viscose (Eurotubo®), 124 samples were seeded (N = 124) in chocolate agar agar, MRSA II and BHI broth (Brain Heart Infusion). Those colonies that were identified by Gram stain gram-positive cocci in clusters available, catalase positive and coagulase positive were processed for study of sensitivity by Kirby-Bauer method and screening test for methicillin (10?g of Oxoid®) on Mueller-Hinton (Becton-Dickinson®, BD), supplemented with NaCl (2%). Those confirmed MRSA isolates, he returned to perform sensitivity study by microdilution (MicroScan®, Siemens) to determine the MIC (mg/L). The prevalence of methicillin-resistant Staphylococcus aureus (MRSA) was 1.61% (1) and 12.90% (8) for methicillin-sensitive Staphylococcus aureus (MSSA), from nostrils. The measures implemented were: nasal application of mupirocin to the worker colonized control isolation measures in infected patients and indoctrination of the personnel involved. PMID:23303255

García-Lozano, Tomás; Egido, Adoración; Contel, Elena; Picón, María Isabel; Martínez, María Ángeles; Aznar, Eduardo

2012-12-01

243

Antimicrobial activity against CA-MRSA and treatment of uncomplicated nonpurulent cellulitis.  

PubMed

Evaluation of: Pallin DJ, Binder WD, Allen MB et al. Clinical trial: comparative effectiveness of cephalexin plus trimethoprim-sulfamethoxazole versus cephalexin alone for treatment of uncomplicated cellulitis: a randomized controlled trial. Clin. Infect. Dis. 56(12), 1754-1762 (2013). The rise of community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) has complicated the empirical antimicrobial treatment of cellulitis. CA-MRSA is frequently the cause of purulent infections, to include purulent cellulitis. The role of CA-MRSA in nonpurulent cellulitis is less clear. Published clinical practice guidelines suggest that CA-MRSA plays only a minor role in nonpurulent cellulitis and that initial treatment should be primarily directed at ?-hemolytic streptococci. Until now, there have been no data from prospective randomized control trials to support this recommendation. In this review, we examine the findings from a recent prospective, double-blind, randomized controlled trial that refutes the need for empirical coverage of CA-MRSA when treating nonpurulent cellulitis. PMID:23944241

Griffith, Matthew E; Ellis, Michael W

2013-08-01

244

Chronic hand eczema - self-management and prognosis: a study protocol for a randomised clinical trial  

PubMed Central

Background Hand eczema has a one-year prevalence of approximately 10 % in the general Danish population. Often the disease becomes chronic with numerous implications for the individual’s daily life, occupation and quality of life. However, no guidelines of self-management recommendations beyond the acute stage are given. Self-management of the disease is pivotal and involves self-monitoring of the condition, medication adherence, and preventive behaviour. Interventions best to support the individual in this ongoing process need to be developed. Methods/design This paper describes the design of a randomised clinical trial to test a newly developed intervention of individual counselling versus conventional information. 300 patients consecutively referred to dermatologic treatment at two different settings are individually randomised to either the intervention programme, named ‘The Healthy Skin Clinic’ or to the control group. Block-wise randomisation according to setting and gender is carried out. The intervention offers a tool for self-monitoring; basic and specific individual counselling; the possibility of asynchronous communication with the intervention team; and an electronic patient dialogue forum. Primary outcome variable is objective assessment of the hand eczema severity performed at baseline prior to randomisation, and repeated at six months follow-up. Secondary outcome variables are dermatology related life quality and perceived global burden of disease. Discussion The trial aims at evaluating a newly developed guidance programme which is expected to support self-management of patients referred to dermatology treatment due to chronic hand eczema. The design of the protocol is pragmatic with blinding of neither participants nor the investigator. Thus, in the interpretation of the results, the investigator takes into account effects that may be attributed to actors of the interventions rather than the intervention per se as well of potential observer bias. Inclusion criterions are wide in order to increase transferability of the results. Trial registration The trial is registered in ClinicalTrials.Gov with registration number NCT01482663.

2012-01-01

245

Discovery of Novel Wall Teichoic Acid Inhibitors as Effective anti-MRSA ?-lactam Combination Agents  

PubMed Central

Summary Innovative strategies are needed to combat drug resistance associated with methicillin-resistant Staphylococcus aureus (MRSA). Here, we investigate the potential of wall teichoic acid (WTA) biosynthesis inhibitors as combination agents to restore ?-lactam efficacy against MRSA. Performing a whole cell pathway-based screen we identified a series of WTA inhibitors (WTAIs) targeting the WTA transporter protein, TarG. Whole genome sequencing of WTAI resistant isolates across two methicillin-resistant Staphylococci spp. revealed TarG as their common target, as well as a broad assortment of drug resistant bypass mutants mapping to earlier steps of WTA biosynthesis. Extensive in vitro microbiological analysis and animal infection studies provide strong genetic and pharmacological evidence of the potential effectiveness of WTAIs as anti-MRSA ?-lactam combination agents. This work also highlights the emerging role of whole genome sequencing in antibiotic mode-of-action and resistance studies.

Wang, Hao; Gill, Charles J.; Lee, Sang H.; Mann, Paul; Zuck, Paul; Meredith, Timothy C.; Murgolo, Nicholas; She, Xinwei; Kales, Susan; Liang, Lianzhu; Liu, Jenny; Wu, Jin; Maria, John Santa; Su, Jing; Pan, Jianping; Hailey, Judy; Mcguinness, Debra; Tan, Christopher M.; Flattery, Amy; Walker, Suzanne; Black, Todd; Roemer, Terry

2013-01-01

246

Discovery of wall teichoic acid inhibitors as potential anti-MRSA ?-lactam combination agents.  

PubMed

Innovative strategies are needed to combat drug resistance associated with methicillin-resistant Staphylococcus aureus (MRSA). Here, we investigate the potential of wall teichoic acid (WTA) biosynthesis inhibitors as combination agents to restore ?-lactam efficacy against MRSA. Performing a whole-cell pathway-based screen, we identified a series of WTA inhibitors (WTAIs) targeting the WTA transporter protein, TarG. Whole-genome sequencing of WTAI-resistant isolates across two methicillin-resistant Staphylococci spp. revealed TarG as their common target, as well as a broad assortment of drug-resistant bypass mutants mapping to earlier steps of WTA biosynthesis. Extensive in vitro microbiological analysis and animal infection studies provide strong genetic and pharmacological evidence of the potential effectiveness of WTAIs as anti-MRSA ?-lactam combination agents. This work also highlights the emerging role of whole-genome sequencing in antibiotic mode-of-action and resistance studies. PMID:23438756

Wang, Hao; Gill, Charles J; Lee, Sang H; Mann, Paul; Zuck, Paul; Meredith, Timothy C; Murgolo, Nicholas; She, Xinwei; Kales, Susan; Liang, Lianzhu; Liu, Jenny; Wu, Jin; Santa Maria, John; Su, Jing; Pan, Jianping; Hailey, Judy; Mcguinness, Debra; Tan, Christopher M; Flattery, Amy; Walker, Suzanne; Black, Todd; Roemer, Terry

2013-02-21

247

A New Local Variant (ST764) of the Globally Disseminated ST5 Lineage of Hospital-Associated Methicillin-Resistant Staphylococcus aureus (MRSA) Carrying the Virulence Determinants of Community-Associated MRSA  

PubMed Central

The ST5 lineage of methicillin-resistant Staphylococcus aureus (MRSA) is one of the most globally disseminated hospital-associated MRSA (HA-MRSA) lineages. We isolated a new local variant (designated ST764) over at least 5 years that causes invasive infections, including necrotizing fasciitis, and is carried by medical students, as well as household members. Analysis of the genome sequence of one isolate compared to that of the reference ST5 strain revealed that ST764 had acquired virulence traits similar to those of community-associated MRSA (CA-MRSA) through the acquisition of two new mobile genetic elements, ACMEII and SaPInn54, which carried ACME arcA and the staphylococcal enterotoxin B gene (seb), respectively, and through enhanced expression of cytolytic peptide genes, although ST764 was negative for Panton-Valentine leukocidin. Other differences between ST764 and ST5 included the acquisition of an ACMEII-related cassette (cJR1), prophage ?2NN54, and streptococcal Tn5251 and decreased numbers of copies of Tn554. As for superantigen genes, although the two possessed seg, sei, sem, sen, and seo, ST764 lacked tst, sec, sel, and sep. The data suggest that ST764 MRSA is a novel hybrid variant of ST5 HA-MRSA with the characteristics of CA-MRSA and that the evolution of ST764 includes multiple steps, e.g., acquisition of novel or nonstaphylococcal mobile elements.

Takano, Tomomi; Hung, Wei-Chun; Shibuya, Michiko; Higuchi, Wataru; Iwao, Yasuhisa; Nishiyama, Akihito; Reva, Ivan; Khokhlova, Olga E.; Yabe, Shizuka; Ozaki, Kyoko; Takano, Misao

2013-01-01

248

A new local variant (ST764) of the globally disseminated ST5 lineage of hospital-associated methicillin-resistant Staphylococcus aureus (MRSA) carrying the virulence determinants of community-associated MRSA.  

PubMed

The ST5 lineage of methicillin-resistant Staphylococcus aureus (MRSA) is one of the most globally disseminated hospital-associated MRSA (HA-MRSA) lineages. We isolated a new local variant (designated ST764) over at least 5 years that causes invasive infections, including necrotizing fasciitis, and is carried by medical students, as well as household members. Analysis of the genome sequence of one isolate compared to that of the reference ST5 strain revealed that ST764 had acquired virulence traits similar to those of community-associated MRSA (CA-MRSA) through the acquisition of two new mobile genetic elements, ACMEII and SaPInn54, which carried ACME arcA and the staphylococcal enterotoxin B gene (seb), respectively, and through enhanced expression of cytolytic peptide genes, although ST764 was negative for Panton-Valentine leukocidin. Other differences between ST764 and ST5 included the acquisition of an ACMEII-related cassette (cJR1), prophage ?2NN54, and streptococcal Tn5251 and decreased numbers of copies of Tn554. As for superantigen genes, although the two possessed seg, sei, sem, sen, and seo, ST764 lacked tst, sec, sel, and sep. The data suggest that ST764 MRSA is a novel hybrid variant of ST5 HA-MRSA with the characteristics of CA-MRSA and that the evolution of ST764 includes multiple steps, e.g., acquisition of novel or nonstaphylococcal mobile elements. PMID:23318800

Takano, Tomomi; Hung, Wei-Chun; Shibuya, Michiko; Higuchi, Wataru; Iwao, Yasuhisa; Nishiyama, Akihito; Reva, Ivan; Khokhlova, Olga E; Yabe, Shizuka; Ozaki, Kyoko; Takano, Misao; Yamamoto, Tatsuo

2013-04-01

249

Endotoxin in inner-city homes: Associations with wheeze and eczema in early childhood  

PubMed Central

Background An inverse association between domestic exposure to endotoxin and atopy in childhood has been observed. The relevance of this aspect of the “hygiene hypothesis” to U.S. inner-city communities that have disproportionately high asthma prevalence has not been determined. Objectives To measure endotoxin in the dust from inner-city homes, evaluate associations between endotoxin and housing/lifestyle characteristics, and determine whether endotoxin exposure predicted wheeze, allergic rhinitis and eczema over the first three years of life. Methods As part of an ongoing prospective birth cohort study, children of Dominican and African-American mothers living in New York City underwent repeated questionnaire measures. Dust samples collected from bedroom floors at age 12 or 36 months were assayed for endotoxin. Results Among the samples collected from 301 participant’s homes, the geometric mean endotoxin concentration [95% C.I.] was 75.9 EU/mg [66–87] and load was 3,892 EU/m2 [3,351–4,522]. Lower endotoxin concentrations were associated with wet mop cleaning and certain neighborhoods. Endotoxin concentration correlated weakly with cockroach (Bla g 2: r=0.22,p<0.001) and mouse (MUP: r=0.28,p<0.001) allergens in the dust. Children in homes with higher endotoxin concentration were less likely to have eczema at age 1 year (O.R. 0.70 [0.53–0.93]) and more likely to wheeze at age 2 years (O.R. 1.34 [1.01–1.78]). These associations were stronger among children with a maternal history of asthma. Conclusions Endotoxin levels in this inner-city community are similar to non-farm homes elsewhere. In this community, domestic endotoxin exposure was inversely associated with eczema at age 1, but positively associated with wheeze at age 2. Clinical Implications Endotoxin exposure in the inner-city community may be related to wheeze in the early life; however, given the inverse association seen with eczema, the long term development of allergic disease is still in question.

Perzanowski, Matthew S.; Miller, Rachel L.; Thorne, Peter S.; Barr, R. Graham; Divjan, Adnan; Sheares, Beverley J.; Garfinkel, Robin S.; Perera, Frederica P.; Goldstein, Inge F.; Chew, Ginger L.

2007-01-01

250

Asthma, eczema, and reports on pollen and cat allergy among pupils in Shanxi province, China  

Microsoft Academic Search

Objectives  To study self-reported asthma, eczema, and pollen and furry pet allergy among pupils (9–20 years) in Shanxi province, China,\\u000a in relation to dietary and environmental factors.\\u000a \\u000a \\u000a \\u000a Methods  A standardised questionnaire was distributed to pupils in two primary and two secondary schools, one in Taiyuan city (3.0\\u000a milj. inhabitants), the others in Qingxu county, a rural area 30 km outside Taiyuan. Totally, 2,116 pupils

D. Norbäck; Z.-H. Zhao; Z.-H. Wang; G. Wieslander; Y.-H. Mi; Z. Zhang

2007-01-01

251

Comparison of sampling methods used for MRSA-classification of herds with breeding pigs.  

PubMed

Since the first report on methicillin resistant Staphylococcus aureus (MRSA) CC398 in pigs, several countries have determined the prevalence of MRSA-positive pig herds using different sampling and laboratory techniques. The objective of the study was to compare three sampling methods for MRSA-classification of herds. Therefore, nasal swabs of pigs and environmental wipes were collected from 147 herds with breeding pigs. Per herd, laboratory examination was done on 10 pools of 6 nasal swabs (NASAL), 5 single environmental wipes (ENVSINGLE) and one pool of 5 environmental wipes (ENVPOOL). Large differences in apparent prevalence of MRSA-positive herds between methods were found: 19.1% for ENVPOOL, 53.1% for ENVSINGLE, and 70.8% for NASAL. Pairwise comparisons of methods resulted in relative sensitivities of 26.9% (ENVPOOL vs. NASAL), 34.6% (ENVPOOL vs. ENVSINGLE), and 72.1% (ENVSINGLE vs. NASAL) with relative specificities of respectively 100%, 98.6% and 93.0%. Cohen's kappa was respectively 0.18, 0.32 and 0.55, thus varying between very poor and moderate agreement. Examination of environmental wipes is an easy and non-invasive method to classify herds for MRSA. The number of environmental wipes needed depends on e.g. required detection limits and within-herd prevalence. In low prevalent herds (e.g. herds with <3 positive pools of nasal swabs), 25 single environmental wipes are required to be 90% sure that MRSA is detected at a detection limit similar to analyzing 10 pools of nasal swabs. Individual analysis of environmental wipes is highly recommended, as pooling 5 environmental samples resulted in a substantial reduction of the apparent prevalence. PMID:20727686

Broens, E M; Graat, E A M; Engel, B; van Oosterom, R A A; van de Giessen, A W; van der Wolf, P J

2011-01-27

252

[Key technologies elements of clinical study of traditional Chinese medicine new drugs on children's dermatitis and eczema].  

PubMed

We assessed and graded the evidence of relevant systematic reviews and randomized controlled trials, combined with our clinical study practice to identify eleven key elements as a focus for the clinical study of traditional Chinese medicine (TCM) new drugs on children's dermatitis and eczema: the primary purpose and design of the study, the inclusion and exclusion criteria of the study, the treatment, the trail procedure,the effectiveness and safety evaluation, and quality control, etc, as well. In addition, seven recommendations for the design of clinical study of TCM new drugs on children's dermatitis and eczema were provided. PMID:24010308

Zhong, Cheng-Liang; Zhang, Chun; Hu, Si-Yuan

2013-06-01

253

Optimal use of MRSASelect and PCR to maximize sensitivity and specificity of MRSA detection.  

PubMed

Suspected colonies of methicillin-resistant Staphylococcus aureus (MRSA) on chromogenic, MRSASelect (BioRad) medium were confirmed using routine microbiological methods, and a multiplex real-time PCR (n = 108). Although the specificity of MRSASelect assessed at 24 h of incubation was much higher than that of 48 h (91.4 vs. 60 %), extending the incubation time to 48 h, along with PCR confirmation, increased the total number of true positive samples by 27.8 %. These results provide a cost effective method for sensitive and specific detection of MRSA. PMID:23053488

Hasan, Mohammad R; Brunstein, John D; Al-Rawahi, Ghada; Tan, Rusung; Thomas, Eva; Tilley, Peter

2013-01-01

254

Intestinal carriage of methicillin-resistant Staphylococcus aureus in nasal MRSA carriers hospitalized in the neonatal intensive care unit  

PubMed Central

Background The current data regarding the correlation between the methicillin-resistant Staphylococcus aureus (MRSA) clones carried in the nasal cavity and digestive tract are inadequate. Methods MRSA strains were isolated from both the feces and nasal swabs of 21 nasal-MRSA carriers ranging from 10 to 104 days of age treated at the neonatal intensive care units of two hospitals. The molecular epidemiological characteristics of the isolates were determined: multilocus sequence types, spa-types, staphylococcal cassette chromosome mec (SCCmec) types, carriage of four exotoxin genes, and genes contained in commercially available kit. Results The feces of all nasal carriers contained MRSA at levels ranging from 4.0 × 102 to 2.8 × 108 colony forming units/g feces. The MRSA clones isolated from the feces and the nasal swabs of each patient were the same. Four MRSA clones, clonal complex (CC) 8-SCCmec IVl, CC8-SCCmec IVb, CC1-SCCmec IVa and CC5-SCCmec IIa were identified from 21 patients. All CC8-SCCmec IVl strains and one of three CC5-SCCmec IIa strains carried the toxic shock syndrome toxin gene. Conclusions The feces of tested MRSA carriers contained the same MRSA clones as the nasal isolates in considerable amounts, suggesting that more careful attention should be paid for the handling of excrement in the case of newborn babies or infants than that of adults.

2014-01-01

255

Isolation measures in the hospital management of methicillin resistant Staphylococcus aureus (MRSA): systematic review of the literature  

Microsoft Academic Search

Objective To evaluate the evidence for the effectiveness of isolation measures in reducing the incidence of methicillin resistant Staphylococcus aureus (MRSA) colonisation and infection in hospital inpatients. Design Systematic review of published articles. Data sources Medline, Embase, CINAHL, Cochrane Library, System for Information on Grey Literature in Europe (SIGLE), and citation lists (1966-2000). Review methods Articles reporting MRSA related outcomes

B S Cooper; S P Stone; C C Kibbler; B D Cookson; J A Roberts; G F Medley; G Duckworth; R Lai; S Ebrahim

2004-01-01

256

Spread and maintenance of a dominant methicillin-resistant Staphylococcus aureus (MRSA) clone during an outbreak of MRSA disease in a Spanish hospital.  

PubMed Central

It was not until November 1989 that the 1,000-bed University-affiliated Hospital de Bellvitge "Princeps d'Espanya" in Barcelona first acquired methicillin-resistant Staphylococcus aureus (MRSA). Since that time, the outbreak of MRSA disease has continued. We have analyzed by genomic DNA fingerprinting 189 MRSA isolates collected between late 1989 and the end of 1993. The isolates include both invasive and colonizing strains as well as isolates from health-care workers and environmental sources. In addition, 52 clinical isolates of methicillin-susceptible S. aureus (MSSA) collected in the same hospital were also analyzed. Isolates were classified into clonal types on the basis of molecular typing techniques. A single MRSA clone (I::B::a) belonging to ClaI type I, pulsed-field gel electrophoretic pattern B, and Tn554 pattern a was responsible for the great majority of infections (73% of blood cultures and 79% of specimens from other clinical sources). This clone appeared at the very beginning of the outbreak, spread throughout the hospital wards, and was also carried by inpatients and health-care workers and on environmental surfaces. In contrast, no dominant lineage was apparent among MSSA isolates (33 distinct pulsed-field gel electrophoretic patterns among 52 isolates). Two MSSA isolates seem to have originated from the dominant clone by deletion of the mecA gene and some additional DNA. In several isolates, different mecA polymorphs were present in identical chromosomal backgrounds or cells with distinct chromosomal backgrounds carried the same mecA polymorph, suggesting horizontal transfer of the mecA gene. Images

Dominguez, M A; de Lencastre, H; Linares, J; Tomasz, A

1994-01-01

257

Alarming Proportions of Methicillin-Resistant Staphylococcus aureus (MRSA) in Wound Samples from Companion Animals, Germany 2010-2012  

PubMed Central

Staphylococcus (S.) aureus is an important cause of wound infections in companion animals, and infections with methicillin-resistant S. aureus (MRSA) are of particular concern due to limited treatment options and their zoonotic potential. However, comparable epidemiological data on MRSA infections in dogs, cats and horses is scarce, also limiting the knowledge about possible links to MRSA isolates from human populations. To gain more knowledge about the occurrence and genotypic variation of MRSA among wound swabs of companion animal origin in Germany we performed a survey (2010–2012) including 5,229 samples from 1,170 veterinary practices. S. aureus was identified in 201 (5.8%) canine, 140 (12.2%) feline and 138 (22.8%) equine swabs from a total of 3,479 canine, 1,146 feline and 604 equine wounds, respectively. High MRSA rates were identified with 62.7%, 46.4% and 41.3% in S. aureus of canine, feline and equine origin, respectively. Further genotyping including spa typing and multilocus sequence typing (MLST) revealed a comparable distribution of spa types among canine and feline MRSA with CC22 (47.6%; 49.2%) and CC5 (30.2%; 29.2%) as predominant lineages followed by CC398 (13.5%; 7.7%) and CC8 (4.0%; 9.2%). In contrast, the majority of equine MRSA belonged to CC398 (87.7%). Our data highlight the importance of S. aureus and MRSA as a cause of wound infections, particularly in cats and horses in Germany. While “human-associated” MRSA lineages were most common in dogs and cats, a remarkable number of CC398-MRSA was detected in horses, indicating a replacement of CC8-MRSA as the predominant lineage within horses in Germany. These data enforce further longitudinal epidemiological approaches to examine the diversity and temporal relatedness of MRSA populations in humans and animals to assess probable sources of MRSA infections. This would enable a sound risk assessment and establishment of intervention strategies to limit the additional spread of MRSA.

Vincze, Szilvia; Stamm, Ivonne; Kopp, Peter A.; Hermes, Julia; Adlhoch, Cornelia; Semmler, Torsten; Wieler, Lothar H.; Lubke-Becker, Antina; Walther, Birgit

2014-01-01

258

Alarming proportions of methicillin-resistant Staphylococcus aureus (MRSA) in wound samples from companion animals, Germany 2010-2012.  

PubMed

Staphylococcus (S.) aureus is an important cause of wound infections in companion animals, and infections with methicillin-resistant S. aureus (MRSA) are of particular concern due to limited treatment options and their zoonotic potential. However, comparable epidemiological data on MRSA infections in dogs, cats and horses is scarce, also limiting the knowledge about possible links to MRSA isolates from human populations. To gain more knowledge about the occurrence and genotypic variation of MRSA among wound swabs of companion animal origin in Germany we performed a survey (2010-2012) including 5,229 samples from 1,170 veterinary practices. S. aureus was identified in 201 (5.8%) canine, 140 (12.2%) feline and 138 (22.8%) equine swabs from a total of 3,479 canine, 1,146 feline and 604 equine wounds, respectively. High MRSA rates were identified with 62.7%, 46.4% and 41.3% in S. aureus of canine, feline and equine origin, respectively. Further genotyping including spa typing and multilocus sequence typing (MLST) revealed a comparable distribution of spa types among canine and feline MRSA with CC22 (47.6%; 49.2%) and CC5 (30.2%; 29.2%) as predominant lineages followed by CC398 (13.5%; 7.7%) and CC8 (4.0%; 9.2%). In contrast, the majority of equine MRSA belonged to CC398 (87.7%). Our data highlight the importance of S. aureus and MRSA as a cause of wound infections, particularly in cats and horses in Germany. While "human-associated" MRSA lineages were most common in dogs and cats, a remarkable number of CC398-MRSA was detected in horses, indicating a replacement of CC8-MRSA as the predominant lineage within horses in Germany. These data enforce further longitudinal epidemiological approaches to examine the diversity and temporal relatedness of MRSA populations in humans and animals to assess probable sources of MRSA infections. This would enable a sound risk assessment and establishment of intervention strategies to limit the additional spread of MRSA. PMID:24465637

Vincze, Szilvia; Stamm, Ivonne; Kopp, Peter A; Hermes, Julia; Adlhoch, Cornelia; Semmler, Torsten; Wieler, Lothar H; Lübke-Becker, Antina; Walther, Birgit

2014-01-01

259

Prevalence of self-reported eczema in relation to living environment, socio-economic status and respiratory symptoms assessed in a questionnaire study  

PubMed Central

Background Potential links between eczema and obstructive pulmonary diseases have been postulated. Previously we have reported the prevalence of upper and lower respiratory diseases and the relation to environmental and socio-economic factors in a randomly selected adult population in southern Sweden using a postal questionnaire. In the present study we wanted to analyse the prevalence of eczema and its relation to socio-economic status, heredity factors and environmental factors in an adult population. Methods Self-reported eczema, upper and lower respiratory symptoms, asthma and Chronic Bronchitis Emphysema (CBE) were examined in 12,071 adults, aged 20–59 years, living in southern Sweden by using a postal questionnaire. There were comparable numbers of males and females in all age groups. Multiple logistic regression analysis (forward conditional) was applied to estimate the association between the proposed risk factors (heredity, self-reported asthma and CBE, nasal symptoms, socio-economic group, environmental factors, age, gender and smoking habits) and self-reported eczema. Results The response rate was 70.1%. In all, 1240 subjects (14.6%) stated that they had eczema. In all age cohorts self-reported eczema was more frequently reported by women than by men (p < 0.05). The prevalence of self-reported eczema among the economically active population varied from 17.1% to 8.2% with the highest rates among assistant non-manual employees. However, when controlling for age, gender and risk occupation there was no association between low social position and eczema. Living close to heavy traffic (OR = 1.45, 95% CI 1.25–1.67) and living seaside (OR = 1.17, 95% CI 1.01–1.35) but not urban/suburban living was associated with eczema. Heredity of eczema (OR = 5.77, 95% CI 5.02–6.64), self reported allergic rhinitis (OR = 2.31, 95% CI 2.00–2.68), self reported asthma (OR = 1.98, 95% CI 1.56–2.51) and self reported CBE (OR = 1.42, 95% CI 1.08–1.87) were all associated with eczema. Conclusions In this epidemiological study we see that self-reported eczema is a common disease in an adult population especially among women. Eczema seems to be linked to environment factors, obstructive pulmonary diseases and rhinitis.

Montnemery, Peter; Nihlen, Ulf; Goran Lofdahl, Claes; Nyberg, Per; Svensson, Ake

2003-01-01

260

Frequency and diversity of molecular epidemiology of methicillin-resistant Staphylococcus aureus (MRSA) isolates from patients of a South West German teaching hospital  

Microsoft Academic Search

We have determined the frequency and the genetic diversity of methicillin-resistant Staphylococcus aureus (MRSA) strains isolated from inpatients of a South West German teaching hospital. The frequency of primary MRSA isolates remained constant over the two-year surveillance period: 108 of the total number of 1450 S. aureus isolates (7.5%) were MRSA in 2001 and the corresponding figures were 110 MRSA

J Abb

2004-01-01

261

Steroid-free emollient formulations reduce symptoms of eczema and improve quality of life.  

PubMed

Two over-the-counter products have been clinically tested for efficacy and tolerability in the treatment of atopic dermatitis. Study 1 evaluated a daily maintenance Body Cream (Eucerin Eczema Relief Body Crème) applied twice daily for 14 days, followed by treatment withdrawal for 5 days (regression period) in subjects with a history of atopic dermatitis. Study 2 evaluated an acute treatment (Eucerin Eczema Relief Instant Therapy [Instant Therapy]) for active atopic dermatitis lesions administered for 14 days. Skin barrier function, hydration, tolerability, and relief of symptoms were assessed at baseline, day 7, and day 14. Study 2 also measured itch relief and treatment impact on work, social activities, and sleep. Body Cream significantly improved skin hydration and barrier function (P<.001) at 14 days, with improvements persisting through the 5-day regression phase. Itching was significantly improved in 93.8% of subjects (P<.001). Instant Therapy treatment of atopic dermatitis lesions significantly improved skin hydration and barrier function, as well as symptoms of erythema, pruritus, excoriation, and lichenification, with rapid improvement of itch reported within minutes of the first treatment application. Instant Therapy significantly reduced itch intensity and frequency, and demonstrated beneficial improvements in subjects' quality of life. Body Cream and Instant Therapy were both safe and well tolerated. PMID:24809884

Weber, Teresa M; Babcock, Michael J; Herndon, James H; Schoelermann, Andrea M; Filbry, Alexander W; Scherdin, Ulrich; Neufang, Gitta; Rippke, Frank

2014-05-01

262

Dissemination of Methicillin-Resistant Staphylococcus aureus (MRSA), USA300 Sequence Type 8 Lineage in Latin-America  

PubMed Central

Background Methicillin-resistant Staphylococus aureus (MRSA) is an important nosocomial and community-associated (CA) pathogen. Recently, a variant of the MRSA USA300 clone emerged and disseminated in South-America causing important clinical problems. Methods S. aureus isolates were prospectively collected (2006 to 2008) from 32 tertiary hospitals in Colombia, Ecuador, Peru, and Venezuela. MRSA isolates were subjected to antimicrobial susceptibility testing, pulsed field gel electrophoresis (PFGE), and categorized as healthcare-associated (HA)-like or CA-like clones based on genotypic characteristics and detection of genes encoding the Panton-Valentine leukocidin (PVL) and staphylococcal cassette mec (SCCmec) IV. Additionally, MLST of representative isolates of each major CA-MRSA pulsotype, and detection of USA300-associated toxins and the arcA gene were performed in all isolates categorized as CA-MRSA. Results A total of 1570 S. aureus were included; 651 were MRSA (41%), with the highest rates of MRSA isolation in Peru (62%), and lowest in Venezuela (26%) and 71%, 27%, and 2% were classified as HA-like, CA-like, and non-CA/HA-like clones, respectively. Only 9 MRSA isolates were confirmed to have reduced susceptibility to glycopeptides (GISA phenotype). The most common pulsotype (designated ComA) amongst the CA-like MRSA strains was found in 96% of isolates with the majority (81%) having ?6 bands difference with the USA300-0114 strain. Representative isolates of this clone were ST8 but, unlike the USA300-0114 strain, they harbored a different SCCmec IV subtype and lacked arcA (an indicator of the arginine catabolic mobile element (ACME)). Conclusion A variant CA-MRSA USA300 clone has now become established in South America and, in some countries, is endemic in hospital settings.

Reyes, Jinnethe; Rincon, Sandra; Diaz, Lorena; Panesso, Diana; Contreras, German A.; Zurita, Jeannete; Carrillo, Carlos; Rizzi, Adele; Guzman, Manuel; Adachi, Javier; Chowdhury, Shahreen; Murray, Barbara E.; Arias, Cesar A.

2009-01-01

263

Methicillin resistant Staphylococcus aureus ST398 in veal calf farming: human MRSA carriage related with animal antimicrobial usage and farm hygiene  

Microsoft Academic Search

Introduction Recently a specific MRSA sequence type, ST398, emerged in food production animals and farmers. Risk factors for carrying MRSA ST398 in both animals and humans have not been fully evaluated. In this cross-sectional study, we investigated factors associated with MRSA colonization in veal calves and humans working and living on these farms. Methods A sample of 102 veal calf

Haitske Graveland; Jaap A. Wagenaar; Hans Heesterbeek; Dik Mevius; Engeline van Duijkeren; Dick Heederik

2010-01-01

264

Evaluation of Vancoplus versus ceftriaxone against cephalosporin resistance MRSA strain in experimental meningitis model.  

PubMed

The aim of this study was to compare the efficacy of ceftriaxone plus vancomycin (Vancoplus) versus ceftriaxone alone against cephalosporin resistant methicillin-resistant Staphylococcus aureus (MRSA) strain by using meningitis mice model. The MRSA strain ATCC 43300 was used to induce meningitis in mice. The mice were fed standard pelleted diet and water ad libitum. The test room was air conditioned with temperature 23 +/- 2 degrees C, humidity 65+/- 5% and with artificial fluorescent light 10-14 hrs. of light and dark, respectively. Twenty four mice were divided into four group containing six rats in each group. The ceftriaxone group received 28.57 mg/Kg body weight/day and the vancoplus group received 42.8 mg/Kg body weight/day and control as well as infected group received normal saline. The bacterial susceptibility test in CSF was performed for cephalosporin resistance MRSA strain by determining the lytic zone for the vancoplus and ceftriaxone antibiotic. The lytic zone was more in vancoplus as compared to ceftriaxone. It was also found that activities of antioxidant enzymes such as catalase were significantly increased (p<0.001) along with decreased (p<0.001) in lipid peroxidation (malonaldialdehyde) level in CSF of vancoplus treated group as compared to infected as well as ceftriaxone resistance group and come back to normal level. It was concluded that vancoplus beneficial for the patients who suffered from cephalosporin resistant MRSA bacterial strain. PMID:20350284

Soni, A; Chaudhary, M; Dwivedi, V K; Kumar, S; Shrivastava, S M

2010-06-01

265

Potential therapeutic failure of generic vancomycin in a liver transplant patient with MRSA peritonitis and bacteremia.  

PubMed

We report a case of generic vancomycin treatment failure in a liver transplant patient with MRSA peritonitis and bacteremia, followed by a rapid sterilization of blood and peritoneal fluid after switching to the branded product. It raises concern about therapeutic equivalence of generic vancomycin. PMID:19698745

Rodriguez, Carlos A; Agudelo, Maria; Cataño, Juan C; Zuluaga, Andres F; Vesga, Omar

2009-10-01

266

Ceftaroline: A New Cephalosporin with Activity against Methicillin-Resistant Staphylococcus aureus (MRSA)  

PubMed Central

Microbial resistance has reached alarming levels, threatening to outpace the ability to counter with more potent antimicrobial agents. In particular, methicillin-resistant Staphylococcus aureus (MRSA) has become a leading cause of skin and soft-tissue infections and PVL-positive strains have been associated with necrotizing pneumonia. Increasing reports of growing resistance to glycopeptides have been noted, further limiting the efficacy of standard antibiotics, such as vancomycin. Ceftaroline is a novel fifth-generation cephalosporin, which exhibits broad-spectrum activity against Gram-positive bacteria, including MRSA and extensively-resistant strains, such as vancomycin-intermediate S. aureus (VISA), heteroresistant VISA (hVISA), and vancomycin-resistant S. aureus (VRSA). In addition to being an exciting new agent in the anti-MRSA armamentarium, ceftaroline provides efficacy against many respiratory pathogens including Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis. Ceftaroline (600 mg intravenously every 12 hours) has been shown effective in phase III studies in the treatment of complicated skin and soft tissue infections and community-acquired pneumonia. To date, this unique antibiotic exhibits a low propensity for inducing resistance and has a good safety profile, although further post-marketing data and clinical experience are needed. In summary, ceftaroline provides an additional option for the management of complex multidrug resistant infections, including MRSA.

Duplessis, Christopher; Crum-Cianflone, Nancy F.

2011-01-01

267

Development and validation of a questionnaire on 'Satisfaction with dermatological treatment of hand eczema' (DermaSat)  

Microsoft Academic Search

OBJECTIVE: To develop a self-administered short questionnaire to assess patient satisfaction with medical treatment for hand eczema (dermatitis) with good psychometric properties. METHOD: The content of the questionnaire was determined on the basis of clinical consultation with groups of patients, from studying the existing instruments, and from discussions with a panel of seven experts. A first draft version containing 38

Miguel A Ruiz; Felipe Heras; Agusti Alomar; Luis Conde-Salazar; Jesús de la Cuadra; Esther Serra; Francisco Regalado; Ralf Halbach

2010-01-01

268

Interstitial del(13)(q21.3q31) associated with psychomotor retardation, eczema, and absent suck and swallowing reflex.  

PubMed Central

A patient with a deletion (13)(q21.3q31) showed only eczema and absent suck and swallowing reflex, in contrast to other well documented cases with a similar deletion. Apparently there is wide clinical variability in patients with deletions in this area. Images

Peet, P J; Pereira, R R; Van Hemel, J O; Hoogeboom, A J

1987-01-01

269

Enhancement of Allergic Skin Wheal Responses by Microwave Radiation from Mobile Phones in Patients with Atopic Eczema\\/Dermatitis Syndrome  

Microsoft Academic Search

Microwave radiation from mobile phones enhanced skin wheal responses induced by house dust mite and Japanese cedar pollen while it had no effect on wheal responses induced by histamine in patients with atopic eczema\\/dermatitis syndrome (AEDS). Microwave radiation also increased plasma levels of substance P (SP) and vasoactive intestinal peptide (VIP) in patients with AEDS. These results indicate that microwave

Hajime Kimata

2002-01-01

270

Staphylococcal Enterotoxin-B-Mediated Stimulation of Interleukin13 Production as a Potential Aetiologic Factor in Eczema in Infants  

Microsoft Academic Search

Background: Staphylococcus aureus colonization has been found in 80–100% of lesional skin from patients with atopic eczema dermatitis syndrome (AEDS) and is thought to have a role in the pathogenesis of the disease. Furthermore, up to 65% of S. aureus from lesional skin has been shown to produce toxigenic superantigens. Methods: Using a cohort of 11 children under 2 years

H. S. Lehmann; T. Heaton; D. Mallon; P. G. Holt

2004-01-01

271

Influence of maternal diet during lactation and use of formula feeds on development of atopic eczema in high risk infants  

Microsoft Academic Search

OBJECTIVE--To examine the effects of maternal diet during lactation and the use of formula feeds on the development of atopic eczema in infants at risk. DESIGN--Mothers who planned to breast feed exclusively were randomly allocated to either a restricted diet (avoiding milk and other dairy products, eggs, fish, peanuts, and soybeans) or a diet without restrictions. Mothers who did not

R. K. Chandra; S. Puri; A. Hamed

1989-01-01

272

Permeability of the small intestine to (/sup 51/Cr)EDTA in children with acute gastroenteritis or eczema  

SciTech Connect

Increased gut permeability to macromolecules is thought to be an important factor in the development of food hypersensitivity. The latter can develop in the course of acute gastroenteritis and could play a role in infantile eczema. The authors studied gut permeability in 10 normal adults, 11 control children, 7 children with acute gastroenteritis, and 8 patients with infantile eczema, making use of (/sup 51/Cr)EDTA as probe molecule. (/sup 51/Cr)EDTA was given orally (50-100 microCi); 24-h urinary excretion of (/sup 51/Cr)EDTA was measured and expressed as a percentage of the oral dose. Mean and standard error were 2.35 +/- 0.24, 2.51 +/- 0.21, 9.96 +/- 3.44, and 10.90 +/- 2.05 in normal adults, control children, and gastroenteritis and eczema patients, respectively. Differences between controls and either gastroenteritis (p less than 0.001) or eczema (p less than 0.001) patients are significant. The results support the hypothesis that increased gut permeability could play a role in food hypersensitivity.

Forget, P.; Sodoyez-Goffaux, F.; Zappitelli, A.

1985-06-01

273

[Methicillin-resistant Staphylococcus aureus (MRSA) in an intensive care unit: a one-year survey].  

PubMed

Methicillin-resistant Staphylococcus aureus (MRSA) is frequently isolated in nosocomial outbreaks. In our study, we analysed the occurrence of colonisation and infection in an Intensive Care Unit of our hospital during a 12-month period. We also evaluated the possibility of using automated ribotyping as a molecular method in order to type the isolates. Twice a week a nasal swab and a rectal swab were performed on all patients; from ventilator-assisted patients, a sputum culture was also taken. All the MRSA isolated were identified by using commonly phenotypic procedures and on all isolates susceptibility tests were performed. An automated ribotyping using EcoRI was also done. Out of 292 patients enrolled in the study, 205 were never colonised (group N); among the other 87 who were colonised by MRSA (29.8%), 40 patients (group A) were MRSA carriers at the time of admission, while 47 (group B) were colonised in the ICU. Twenty-seven patients (11 from group A, 15 from group B and 1 from group N) developed 31 infections due to MRSA. Patients from group A exhibited, as a rule, worse clinical conditions than those from the other two groups. For the former group, MRSA infection was frequently systemic (sepsis), while in group B pneumonia was the predominant infection. The prevalence of colonisations in our study was 30%, which is a value comparable to those presented by other authors in similar cases. MRSA colonisation is a necessary condition for subsequent infections in almost all cases, with an average lag of 7 days. Susceptibility tests were non-discriminating among the isolates: all the strains were susceptible to glycopeptides; nearly all of them were resistant to erythromycin, clindamycin, ciprofloxacin and gentamicin. Automated ribotyping allowed us to distinguish 12 different ribogroups, the most frequent of which was composed of 146 isolates. In our study, this molecular method was able to define a possible endemic clone that should be better investigated by using methods with a higher discriminatory power, such as RAPD or PFGE. The method that we employed is highly reliable, easy to perform and not time-consuming. In our opinion, it could be the method of choice in the first screening of high numbers of isolates. PMID:12087212

Barbarini, D; Fumagalli, P; Marone, P; Marzani, F C; Braschi, A; Emmi, V; Carretto, E

2001-12-01

274

Rapid Whole-Genome Sequencing for Investigation of a Neonatal MRSA Outbreak  

PubMed Central

Background Isolates of methicillin-resistant Staphylococcus aureus (MRSA) belonging to a single lineage are often indistinguishable by means of current typing techniques. Whole-genome sequencing may provide improved resolution to define transmission pathways and characterize outbreaks. Methods We investigated a putative MRSA outbreak in a neonatal intensive care unit. By using rapid high-throughput sequencing technology with a clinically relevant turnaround time, we retrospectively sequenced the DNA from seven isolates associated with the outbreak and another seven MRSA isolates associated with carriage of MRSA or bacteremia in the same hospital. Results We constructed a phylogenetic tree by comparing single-nucleotide polymorphisms (SNPs) in the core genome to a reference genome (an epidemic MRSA clone, EMRSA-15 [sequence type 22]). This revealed a distinct cluster of outbreak isolates and clear separation between these and the nonoutbreak isolates. A previously missed transmission event was detected between two patients with bacteremia who were not part of the outbreak. We created an artificial “resistome” of antibiotic-resistance genes and demonstrated concordance between it and the results of phenotypic susceptibility testing; we also created a “toxome” consisting of toxin genes. One outbreak isolate had a hypermutator phenotype with a higher number of SNPs than the other outbreak isolates, highlighting the difficulty of imposing a simple threshold for the number of SNPs between isolates to decide whether they are part of a recent transmission chain. Conclusions Whole-genome sequencing can provide clinically relevant data within a time frame that can influence patient care. The need for automated data interpretation and the provision of clinically meaningful reports represent hurdles to clinical implementation. (Funded by the U.K. Clinical Research Collaboration Translational Infection Research Initiative and others.)

Koser, Claudio U.; Holden, Matthew T.G.; Ellington, Matthew J.; Cartwright, Edward J.P.; Brown, Nicholas M.; Ogilvy-Stuart, Amanda L.; Hsu, Li Yang; Chewapreecha, Claire; Croucher, Nicholas J.; Harris, Simon R.; Sanders, Mandy; Enright, Mark C.; Dougan, Gordon; Bentley, Stephen D.; Parkhill, Julian; Fraser, Louise J.; Betley, Jason R.; Schulz-Trieglaff, Ole B.; Smith, Geoffrey P.; Peacock, Sharon J.

2013-01-01

275

Comparative Characterisation of Genotypically Different Clones of MRSA in the Production of Biofilms  

PubMed Central

The ability to adhere and produce biofilms is characteristic of enhanced virulence among isolates of methicillin-resistant Staphylococcus aureus (MRSA). The aim of the study is to find out whether these characteristics are consistently similar among isolates variations of MRSA. The study used 30 various isolates of MRSA belong to 13 spa types and 5 MLST types and determined the aggregation, the adherence, and the production of biofilms and slime for each isolate. The methods used to evaluate these characteristics were a modified Congo red agar assay (MCRA), a microtiter plate assay (MPA), high-magnification light microscopy, scanning electron microscopy (SEM), and PCR. The study found that isolates belonging to similar Spa, SCCmec, and ST types have similar abilities to produce biofilms; however, their ability to produce slime on CRA was found to be different. Moreover, isolates that have different Spa types showed high variation in their ability to produce biofilms. The results of light microscope revealed the isolates that produced strong and weak biofilms and formed similar aggregation on the glass surfaces. SEM results showed that all 30 MRSA isolates that were tested were 100% positive for biofilm formation, although to varying degrees. Further testing using PCR confirmed that 100% of the 30 isolates tested were positive for the presence of the icaADBC, fnbA, eno, ebps, clfA, and clfB genes. The prevalence of fib, cna, fnbB, and bbp in MRSA clones was 90, 93.33, 53.33, and 10%, respectively. This study indicate that differences in biofilm production capacities are caused by the differences in surface protein A (Spa) type and are not due to differences in MLST and SCCmec types.

Atshan, Salman Sahab; Shamsudin, Mariana Nor; Thian Lung, Leslie Than; Sekawi, Zamberi; Ghaznavi-Rad, Ehsanollah; Pei Pei, Chong

2012-01-01

276

Increase in chronic or recurrent rhinitis, rhinoconjunctivitis and eczema among schoolchildren in Greece: three surveys during 1991-2003.  

PubMed

The prevalence of allergic rhinitis, hay fever and eczema has risen worldwide during the last four decades but may have reached a plateau in some westernized societies. We examined time trends in the prevalence of childhood chronic or recurrent rhinitis, rhinoconjunctivitis and eczema in urban Greece. Using identical methodology, three population-based cross-sectional parental questionnaire surveys on current (last two years) and lifetime allergic symptoms of the nose, eyes and skin were performed among 8-10-yr-old children in 1991, 1998 and 2003 in Patras, Greece. Exactly 2417, 3006 and 2725 questionnaires were completed in 1991, 1998 and 2003, respectively. Prevalence rates of current (lifetime) symptoms of chronic or recurrent rhinitis were 5.1% (6.0%) for 1991, 6.5% (8.0%) for 1998 and 8.0% (9.8%) for 2003. Respective values for rhinoconjunctivitis were 1.8% (2.1%), 2.7% (3.4%) and 3.6% (4.6%) and for eczema 2.5% (4.5%), 3.4% (6.3%) and 5.0% (9.5%) (p for trend <0.001). Among current asthmatics there was an increase in lifetime rhinitis (p = 0.038), current (p = 0.025) and lifetime rhinoconjunctivitis (p = 0.007) and current (p = 0.001) and lifetime eczema (p < 0.001); male predominance increased throughout the study. The proportion of atopic asthma (current asthma with chronic or recurrent rhinitis and/or rhinoconjunctivitis and/or eczema) increased during the same period (p < 0.001). In conclusion, there is a continuous increase in the prevalence of allergic manifestations among preadolescent children in Patras, Greece during the period 1991-2003. In our population, boys have contributed to this increase more than girls and the increase of atopy is, at least partially, responsible for the increase of asthma. PMID:18433422

Anthracopoulos, Michael B; Antonogeorgos, George; Liolios, Evangelos; Triga, Maria; Panagiotopoulou, Eugenia; Priftis, Kostas N

2009-03-01

277

Use of Triplex PCR for Rapid Detection of PVL and Differentiation of MRSA from Methicillin Resistant Coagulase Negative Staphylococci  

PubMed Central

Introduction: Methicillin-Resistant Staphylococcus aureus (MRSA) has become a major public health problem in both hospitals and communities. Panton – Valentine Leucocidin (PVL) has been reported to be an important marker for the highly pathogenic community acquired S. aureus infections. A rapid detection of these MRSA is very important for its treatment. The specific detection of MRSA is always a problem due to the prevalence of methicillin resistance among the coagulase negative Staphylococci. Hence, this study was done to develop a rapid triplex PCR for the detection of PVL positive MRSA and for the simultaneous differentiation of MRSA from Coagulase Negative Staphylococci (CoNS). Materials and Methods: We developed a triplex PCR for the specific detection of PVL positive Community Acquired (CA) – MRSA and for its simultaneous differentiation from the coagulase negative Staphylococci. We used PCR for targeting the fem A gene which is specific for S. aureus, mecA which is specific for methicillin-resistance and luk - PV which is specific for the PVL toxin. The method was evaluated with a total of 100 clinical isolates of Staphylococcus spp. Results: The triplex PCR was successfully standardized by using the reference strains and it was evaluated by using clinical strains. The method was found to be rapid, highly sensitive (100%), specific (99%) and cost effective. Conclusion: Triplex PCR can be used as a diagnostic tool for the detection of the highly pathogenic strains of CA-MRSA.

Abimanyu, Nagarajan; Krishnan, Arunkumar; Murugesan, Saravanan; Subramanian G, Kaushik; Gurumurthy, Sivakumar; Krishnan, Padma

2013-01-01

278

Survey of policy for MRSA screening in English cataract surgical units and changes to practice after updated National guidelines  

PubMed Central

Background National guidelines on MRSA (methicillin-resistant Staphylococcus aureus) screening policy in England have changed on a number of occasions, but there is limited data on its influence at a local level. The aim of this study was to determine if changes in National policy influenced preoperative screening of cataract patients for MRSA. Methods A structured telephone survey was conducted on all 133 ophthalmology units in England in 2004 and again in 2007 for the initial responders, after a change in national policy. Results A total of 74 units (56%) responded in 2004 and 71 units (96% of initial respondents) in 2007. In 2004, 57% of units screened for MRSA. They screened groups at high risk of carriage, including patients with previous MRSA (93%) and patients from Nursing homes (21%). Swab sites included the nose (100%), eyes (31%) and perineum (62%). In 2007, there was no significant change in the number of units that screened for MRSA (57% vs 66%; p?=?0.118; McNemar test). However, more units screened for MRSA in patients from nursing/residential homes (21% vs 51%; p?=?0.004, McNemar test), and in patients who had recent admission to hospital (12% vs 36%; p?=?0.003). In the second survey, 3 units (6%) now screened patients who were close relatives of MRSA carriers. Conclusion This survey has highlighted inconsistences in MRSA screening practice of day-case cataract surgery patients across England after 2 major national policy changes. A change in DoH policy only led to more units screening patients for MRSA from high risk groups.

2013-01-01

279

Dyshidrotic eczema  

MedlinePLUS

... if you scratch in your sleep. Apply an ointments or creams to your hands at least two ... per day, and after every hand washing. Heavy ointments are best. Petroleum jelly (such as Vaseline), mineral ...

280

Low dose versus medium dose UV-A1 treatment in severe atopic eczema.  

PubMed

Twenty-two patients with severe atopic eczema were included in a therapy study with UV-A1 (wavelengths > 340 nm) treatment. The patients were divided into two dose groups, each consisting of 11 patients. One group received 10 J/cm2 and the other 50 J/cm2 five times a week for 3 consecutive weeks. No topical or systemical steroids or antihistamines were allowed. Using the SCORAD index as a measure of disease activity before onset of therapy and after 10 and 15 treatments, we observed a significant improvement in both dose groups after 15 treatments (10 J/cm2: p < 0.05, 50 J/cm2: p < 0.005). After 10 treatments only the improvement in the 50 J/cm2 group was significant (p < 0.005); the difference between the two dose groups was significant (p < 0.05). The clinical efficacy of treatment was reflected neither by a decrease of serum IgE nor by a decrease of elevated serum levels of soluble adhesion molecules sICAM-1 and sELAM-1 in the two dose groups. In contrast, a marked but not significant decrease of serum ECP could be observed in the 50 J/cm2 group only. We conclude from these and other published data that although 10 J/cm2 UV-A1 has a limited effect on patients with severe atopic eczema, higher doses are of higher efficiency in the treatment of this condition. PMID:7538257

Kowalzick, L; Kleinheinz, A; Weichenthal, M; Neuber, K; Köhler, I; Grosch, J; Lungwitz, G; Seegeberg, C; Ring, J

1995-01-01

281

Improved exposure characterization with robotic (PIPER) sampling and association with children's respiratory symptoms, asthma and eczema.  

PubMed

Particulate matter (PM) and its constituents are recognized risk factors for the development of respiratory symptoms and illness in children. Most measurements of exposure have relied upon stationary indoor monitors (SIMs), overlooking the role of resuspended PM. To improve exposure characterization to resuspended aerosol PM, a recently developed methodology has been employed. The goal of this study was to characterize the resuspendable fraction of house dust and early childhood exposures to PM and its constituents in the child's home and compare conventional SIM and the Pre-toddler Inhalable Particulate Environmental Robotic (PIPER), an innovative mobile sampler. The study seeks to demonstrate that PIPER provides a more relevant estimate of exposure from inhalable particulate matter through improved correlation with respiratory symptoms in young children. Seventy-five households with children between 3 and 59 months of age were recruited from clinics in central New Jersey. Demographic information, and responses to a health questionnaire based upon that used by the International Study of Allergies and Asthma in Childhood (ISAAC), and household data were collected. Household exposures to inhalable PM (PM100) and endotoxin were determined with simultaneous SIM and mobile (PIPER) sampling. Univariate and multivariate analyses were carried out. History of wheeze ("recent" (<1 year) and "ever"), cough, asthma and eczema was evaluated. Multivariate analysis models included PM100 and endotoxin levels by tertiles of exposure. Risk of asthma for the highest tertile of PM100, as measured by PIPER (odds ratio=4.2; 95% confidence interval 0.7-24.0), was compared with measurements by SIM (odds ratio=0.7; 95% confidence interval 0.2-2.6). Measurements of PM and its constituents with PIPER are more strongly associated with asthma, eczema and wheeze compared with measurements using SIMs. Application of this methodology may provide useful insights into early childhood exposures related to the etiology of childhood illnesses associated with inhalation exposures. PMID:24802555

Ramagopal, Maya; Wang, Zuocheng; Black, Kathleen; Hernandez, Marta; Stambler, Adam A; Emoekpere, Osiloke H; Mainelis, Gediminas; Shalat, Stuart L

2014-07-01

282

Global Expression Profiling in Atopic Eczema Reveals Reciprocal Expression of Inflammatory and Lipid Genes  

PubMed Central

Background Atopic eczema (AE) is a common chronic inflammatory skin disorder. In order to dissect the genetic background several linkage and genetic association studies have been performed. Yet very little is known about specific genes involved in this complex skin disease, and the underlying molecular mechanisms are not fully understood. Methodology/Findings We used human DNA microarrays to identify a molecular picture of the programmed responses of the human genome to AE. The transcriptional program was analyzed in skin biopsy samples from lesional and patch-tested skin from AE patients sensitized to Malassezia sympodialis (M. sympodialis), and corresponding biopsies from healthy individuals. The most notable feature of the global gene-expression pattern observed in AE skin was a reciprocal expression of induced inflammatory genes and repressed lipid metabolism genes. The overall transcriptional response in M. sympodialis patch-tested AE skin was similar to the gene-expression signature identified in lesional AE skin. In the constellation of genes differentially expressed in AE skin compared to healthy control skin, we have identified several potential susceptibility genes that may play a critical role in the pathological condition of AE. Many of these genes, including genes with a role in immune responses, lipid homeostasis, and epidermal differentiation, are localized on chromosomal regions previously linked to AE. Conclusions/Significance Through genome-wide expression profiling, we were able to discover a distinct reciprocal expression pattern of induced inflammatory genes and repressed lipid metabolism genes in skin from AE patients. We found a significant enrichment of differentially expressed genes in AE with cytobands associated to the disease, and furthermore new chromosomal regions were found that could potentially guide future region-specific linkage mapping in AE. The full data set is available at http://microarray-pubs.stanford.edu/eczema.

Saaf, Annika M.; Tengvall-Linder, Maria; Chang, Howard Y.; Adler, Adam S.; Wahlgren, Carl-Fredrik; Scheynius, Annika; Nordenskjold, Magnus; Bradley, Maria

2008-01-01

283

Evaluation of the IDI-MRSA Assay for Detection of Methicillin-Resistant Staphylococcus aureus from Nasal and Rectal Specimens Pooled in a Selective Broth  

PubMed Central

Rapid detection of methicillin-resistant Staphylococcus aureus (MRSA) by PCR can be performed directly from nasal specimens with the IDI-MRSA assay. To improve the efficiency of screening, we evaluated the performance of the IDI-MRSA assay for the detection of MRSA from pooled and unpooled specimens cultured in a selective broth. Of the 287 specimens evaluated, 71 were culture and PCR positive, 203 were culture and PCR negative, 3 were culture positive and PCR negative, 8 were culture negative and PCR positive, and 2 remained inhibited. A methicillin-susceptible Staphylococcus aureus isolate was recovered from five of the eight specimens with false-positive PCR results. Compared to the results of culture, the sensitivity, specificity, and negative and positive predictive values of the IDI-MRSA assay for detection of MRSA from broth were 96%, 96%, 90%, and 98%, respectively. Following implementation of the IDI-MRSA assay, PCR-positive broths were subcultured for evaluation of assay performance. Of the 298 IDI-MRSA assay-positive broths, the results for 103 could not be confirmed by culture. A methicillin-susceptible S. aureus (MSSA) isolate was recovered from 77 of these 103 broths. Repeat testing by the IDI-MRSA assay directly with the MSSA isolates confirmed the original positive PCR result. The positive predictive value of the IDI-MRSA assay fell from 90% during the evaluation phase to 65% postimplementation. The IDI-MRSA assay performed well for the detection of MRSA from a selective broth compared to the performance of the detection of MRSA from culture. However, because of the burden associated with implementation of infection control precautions, cultures remain essential in confirming positive IDI-MRSA results.

Desjardins, M.; Guibord, Christiane; Lalonde, B.; Toye, B.; Ramotar, K.

2006-01-01

284

Two Distinct Clones of Methicillin-Resistant Staphylococcus aureus (MRSA) with the Same USA300 Pulsed-Field Gel Electrophoresis Profile: a Potential Pitfall for Identification of USA300 Community-Associated MRSA?  

PubMed Central

Analysis of methicillin-resistant Staphylococcus aureus (MRSA) characterized as USA300 by pulsed-field gel electrophoresis identified two distinct clones. One was similar to community-associated USA300 MRSA (ST8-IVa, t008, and Panton-Valentine leukocidin positive). The second (ST8-IVa, t024, and PVL negative) had different molecular characteristics and epidemiology, suggesting independent evolution. We recommend spa typing and/or PCR to discriminate between the two clones.

Larsen, Anders Rhod; Goering, Richard; Stegger, Marc; Lindsay, Jodi A.; Gould, Katherine A.; Hinds, Jason; S?rum, Marit; Westh, Henrik; Boye, Kit; Skov, Robert

2009-01-01

285

Maternal meat and fat consumption during pregnancy and suspected atopic eczema in Japanese infants aged 3-4 months: the Osaka Maternal and Child Health Study.  

PubMed

Interest has increased in the possibility that maternal dietary intake during pregnancy might influence the development of allergic disorders in children. The present prospective study examined the association of maternal intake of selected foods high in fatty acids and specific types of fatty acids during pregnancy with the risk of suspected atopic eczema among Japanese infants aged 3-4 months. Subjects were 771 mother-child pairs. Information on maternal dietary intake during pregnancy was assessed with a validated self-administered diet history questionnaire. The term 'suspected atopic eczema' was used to define an outcome based on results of our questionnaire completed by mothers 3-4 months postpartum. The risk of suspected atopic eczema was 8.4% (n = 65). Higher maternal intake of meat during pregnancy was significantly associated with an increased risk of suspected atopic eczema in the offspring: the multivariate odds ratio (OR) for the highest vs. lowest quartile was 2.59 [95% confidence interval (CI): 1.15-6.17, p for trend = 0.01]. The positive association was strengthened when the definition of the outcome was confined to a definite physician's diagnosis of atopic eczema (n = 35): the multivariate OR between extreme quartiles was 3.53 (95% CI: 1.19-12.23, p for trend = 0.02). No material exposure-response relationships were observed between maternal intake of eggs, dairy products, fish, total fat, saturated fatty acids, monounsaturated fatty acids, n-3 polyunsaturated fatty acids, alpha-linolenic acid, eicosapentaenoic acid, docosahexaenoic acid, n-6 polyunsaturated fatty acids, linoleic acid, arachidonic acid and cholesterol and the ratio of n-3 to n-6 polyunsaturated fatty acid consumption and the risk of suspected atopic eczema. Higher maternal meat intake may increase the risk of infantile atopic eczema, whereas we found no evidence that maternal intake of fish and n-3 polyunsaturated fatty acids are preventive against infantile atopic eczema. PMID:19552790

Saito, Kyoko; Yokoyama, Tetsuji; Miyake, Yoshihiro; Sasaki, Satoshi; Tanaka, Keiko; Ohya, Yukihiro; Hirota, Yoshio

2010-02-01

286

Comparison of Xpert MRSA/SA Nasal and MRSA/SA ELITe MGB Assays for Detection of the mecA Gene with Susceptibility Testing Methods for Determination of Methicillin Resistance in Staphylococcus aureus Isolates  

PubMed Central

In a series of 82 Staphylococcus strains isolated from culture, 100% were identified as Staphylococcus aureus by matrix-assisted laser desorption ionization–time of flight mass spectrometry (MALDI-TOF MS); 99.9% (77/82) of them were resistant to benzylpenicillin, oxacillin, and cefoxitin, and 6.1% (5/82) were susceptible to methicillin. Xpert MRSA/SA assay results were concordant with the phenotypic results in 76.8% (63/82) of cases and discordant in 23.2% (19/82) of cases. The MRSA/SA ELITe MGB kit results were concordant with phenotypic results in 100% of the cases. When comparing the Xpert MRSA/SA assay results with the MRSA/SA ELITe MGB kit results, 78% (64/82) of the cases were concordant, while 22% (18/82) of the cases were discordant. No statistically significant differences were observed between the two techniques. The PCR protocol that was used to validate the results of these two methods gave the following results: 49 were conventional methicillin-resistant S. aureus (MRSA) isolates (mecA positive and mecALGA251 negative), and 25 were phenotypic MRSA isolates (mecA negative and mecALGA251 positive).

Belmekki, Mohamed; Mammeri, Hedi; Hamdad, Farida; Rousseau, Florence; Canarelli, Brigitte

2013-01-01

287

Typing of methicillin-resistant Staphylococcus aureus (MRSA) strains from an intensive care unit by random amplified polymorphic DNA (RAPD).  

PubMed

The identification and control of methicillin-resistant Staphylococcus aureus (MRSA) is of primary concern in intensive care units (ICUs) worldwide. The introduction and circulation of particular strains is best studied by genomic procedures and random amplified polymorphic DNA (RAPD) is well suited for this task. In this study 14 isolates of MRSA, obtained over an 8 month period from the blood cultures of 12 patients in an ICU at our hospital, were typed by RAPD method using seven primers. Three separate groups were distinguished and clustering of certain types in time and space was noted. These results suggest that although different strains of MRSA were involved in this outbreak, cross-infection with individual types occurred. RAPD fingerprinting is a relatively simple method that allows epidemiologic investigation of MRSA outbreaks in hospital infection. PMID:10555202

Telecco, S; Barbarini, D; Carretto, E; Comincini, S; Emmi, V; Marone, P

1999-10-01

288

MRSA carriage among healthcare workers in non-outbreak settings in Europe and the United States: a systematic review  

PubMed Central

Abstarct Background A recent review estimated prevalence of methicillin-resistant Staphylococcus aureus (MRSA) in healthcare workers (HCWs) to be 4.6%. However, MRSA carriage in HCWs in non-outbreak settings is thought to be higher than in an outbreak situation, due to increased hygiene awareness in outbreaks, but valid data are missing. The goals of this paper are to summarise the prevalence of MRSA carriage amongst HCWs in non-outbreak situations and to identify occupational groups in healthcare services associated with a higher risk of MRSA colonisation. Methods A systematic search for literature was conducted in the MEDLINE and EMBASE databases. The methodological quality of the studies was assessed using seven criteria. Pooled prevalence rates were calculated. Pooled effect estimates were identified in a meta-analysis. Results 31 studies were included in this review. The pooled MRSA colonisation rate was 1.8% (95% confidence interval [CI], 1.34%-2.50%). The rate increased to 4.4% (95% CI, 3.98%-4.88%) when one study from the Netherlands was excluded. The pooled MRSA rate was highest in nursing staff (6.9%). Nursing staff had an odds ratio of 1.72 (95% CI, 1.07-2.77) when compared with medical staff and an odds ratio of 2.58 (95%, 1.83-3.66) when compared with other healthcare staff. Seven studies were assessed as being of high quality. The pooled MRSA prevalence in high quality studies was 1.1% or 5.4% if the one large study from the Netherlands is not considered. The pooled prevalence in studies of moderate quality was 4.0%. Conclusions MRSA prevalence among HCWs in non-outbreak settings was no higher than carriage rates estimated for outbreaks. Our estimate is in the lower half of the range of the published MRSA rates in the endemic setting. Our findings demonstrate that nursing staff have an increased risk for MRSA colonisation. In order to confirm this finding, more studies are needed, including healthcare professionals with varying degrees of exposure to MRSA. In order to reduce misclassification bias, standardisation of HCWs screening is warranted.

2014-01-01

289

Cardiac tamponade complicating purulent pericarditis due to community acquired methicilin resistant Staphylococcus aureus (CA-MRSA).  

PubMed

Community acquired methicillin resistant Staphylococcus aureus(CA-MRSA) is a global pathogen capable of causing life-threatening infections with increasing prevalence since the 1990s. Purulentpericarditis, characterized by accumulation of purulent fluid in the pericardial space was historically a disease of the pediatric and early adult population, but through the years the median age of diagnosis has increased from 21 to 49. Mortality rates are as high as 40% even in the treated population. We report a case of purulent pericarditis due to CA-MRSA that was complicated by cardiac tamponade. Early diagnosis and intervention proved to be life-saving. A brief review of the literature and current management options are discussed. PMID:24772835

Bagavathy, Kavitha; Raju, Shine K; Joseph, Ranjit; Kumar, Anupam

2014-03-01

290

Evaluation of the Combined Effects of Stilbenoid from Shorea gibbosa and Vancomycin against Methicillin-Resistant Staphylococcus aureus (MRSA).  

PubMed

The aim of this study is to determine the combined effects of stilbenoids from Shorea gibbosa and vancomycin against methicillin-resistant Staphylococcus aureus (MRSA). A total of nine pure compounds, five stilbenoid dimers ?-viniferin, ampelopsin A, balanocarpol, laevifonol and diptoindonesin G and four stilbenoid trimers a-viniferin, johorenol A, ampelopsin E and vaticanol G were evaluated for their antibacterial activities against ATCC 33591 and a HUKM clinical isolate. Minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) for each active compound were determined using the serial microdilution and plate-streak techniques. The combined effect of stilbenoids with vancomycin against MRSA was evaluated using the checkerboard assay to determine their fractional inhibitory concentration (FIC) index values. The MIC value of a-viniferin on both MRSA strains was 100 ?g/mL, whereas those of johorenol A on ATCC 33591 and HUKM strain were 100 ?g/mL and 200 ?g/mL, respectively. The MIC values of ampelopsin E and vaticanol G were higher than 400 ?g/mL. Out of the five stilbenoid dimers, only ?-viniferin was capable of inhibiting the growth of both MRSA strains at MIC 400 ?g/mL. The MBC value of ?-viniferin, a-viniferin and johorenol A showed bacteriostatic action against MRSA. The FIC index value of ?-viniferin and a-viniferin in combination with vancomycin showed an additive effect (0.5 < FIC ? 2.0) against both MRSA strains. Johorenol A-vancomycin combination was also additive against HUKM strain, but it showed synergistic interaction with vancomycin against ATCC 33591 (FIC < 0.5). Stilbenoid compounds from Shorea gibbosa have anti-MRSA activity and huge potential as an alternative phytotherapy in combating MRSA infections. PMID:24280704

Basri, Dayang Fredalina; Luoi, Chan Kin; Azmi, Abdul Muin; Latip, Jalifah

2012-01-01

291

Daptomycin resistance and treatment failure following vancomycin for methicillin-resistant Staphylococcus aureus (MRSA) mitral valve acute bacterial endocarditis (ABE)  

Microsoft Academic Search

Acute bacterial endocarditis (ABE) is most commonly due to virulent pathogens, i.e., Staphylococcus aureus. S. aureus ABE may be due to methicillin-sensitive (MSSA) or methicillin-resistant (MRSA) strains and, optimally, ABE should be treated\\u000a with bactericidal antibiotics. Traditionally, vancomycin has long been used to treat MRSA ABE, but it has been shown that\\u000a vancomycin may increase the staphylococcal the thickness, resulting

B. A. Cunha; F. M. Pherez

2009-01-01

292

Evaluation of the Combined Effects of Stilbenoid from Shorea gibbosa and Vancomycin against Methicillin-Resistant Staphylococcus aureus (MRSA)  

PubMed Central

The aim of this study is to determine the combined effects of stilbenoids from Shorea gibbosa and vancomycin against methicillin-resistant Staphylococcus aureus (MRSA). A total of nine pure compounds, five stilbenoid dimers ?-viniferin, ampelopsin A, balanocarpol, laevifonol and diptoindonesin G and four stilbenoid trimers ?-viniferin, johorenol A, ampelopsin E and vaticanol G were evaluated for their antibacterial activities against ATCC 33591 and a HUKM clinical isolate. Minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) for each active compound were determined using the serial microdilution and plate-streak techniques. The combined effect of stilbenoids with vancomycin against MRSA was evaluated using the checkerboard assay to determine their fractional inhibitory concentration (FIC) index values. The MIC value of ?-viniferin on both MRSA strains was 100 ?g/mL, whereas those of johorenol A on ATCC 33591 and HUKM strain were 100 ?g/mL and 200 ?g/mL, respectively. The MIC values of ampelopsin E and vaticanol G were higher than 400 ?g/mL. Out of the five stilbenoid dimers, only ?-viniferin was capable of inhibiting the growth of both MRSA strains at MIC 400 ?g/mL. The MBC value of ?-viniferin, ?-viniferin and johorenol A showed bacteriostatic action against MRSA. The FIC index value of ?-viniferin and ?-viniferin in combination with vancomycin showed an additive effect (0.5 < FIC ? 2.0) against both MRSA strains. Johorenol A-vancomycin combination was also additive against HUKM strain, but it showed synergistic interaction with vancomycin against ATCC 33591 (FIC < 0.5). Stilbenoid compounds from Shorea gibbosa have anti-MRSA activity and huge potential as an alternative phytotherapy in combating MRSA infections.

Basri, Dayang Fredalina; Luoi, Chan Kin; Azmi, Abdul Muin; Latip, Jalifah

2012-01-01

293

Practical Management: Community-Associated Methicillin-Resistant Staphylococcus Aureus (CA-MRSA): The Latest Sports Epidemic  

Microsoft Academic Search

Community-associated methicillin-resistant Staphylococ- cus aureus (CA-MRSA) has gained international recognition as a superbug that causes serious infectious outbreaks in high-risk populations such as athletes. Clusters of cases in various athletic teams, particularly contact sports, have been reported since 1993 in the United States and more recently in Canada. CA-MRSA infections are not limited to North America, and all athletes are

Holly J. Benjamin; Vineet Nikore; Josh Takagishi

2007-01-01

294

MRSA-Infected External Iliac Artery Pseudoaneurysm Treated with Endovascular Stenting  

Microsoft Academic Search

A 48-year-old woman with severe juvenile-onset rheumatoid arthritis presented with a bleeding cutaneous sinus distal to her right total hip replacement scar. Methicillin resistant Staphylococcus aureus (MRSA) was isolated on culture. She had previously undergone bilateral total hip and knee replacements at aged 23 and six years later had the right knee prosthesis removed for infection, with subsequent osteomyelitis of

M. G. Clarke; H. G. Thomas; J. F. Chester

2005-01-01

295

Draft Genome Sequence of the Methicillin-Resistant Staphylococcus aureus Isolate MRSA-M2  

PubMed Central

We report the draft genome sequence of a methicillin-resistant strain of Staphylococcus aureus, designated MRSA-M2. This clinical isolate was obtained from an osteomyelitis patient undergoing treatment at the University of Texas Medical Branch (Galveston, TX). This strain is an ST30, spa type T019, agr III strain and has been utilized as a model S. aureus strain in a number of proteomic, transcriptomic, and animal model studies.

Harro, Janette M.; Daugherty, Sean; Bruno, Vincent M.; Jabra-Rizk, Mary Ann; Rasko, David A.

2013-01-01

296

Prevention of MRSA pneumonia by oral vancomycin decontamination: a randomised trial  

Microsoft Academic Search

This study was undertaken to assess whether oropharyngeal vancomycin may control oropharyngeal carriage and lower airway infection due to methicillin- resistant Staphylococcus aureus (MRSA) acquired in the intensive care unit (ICU). Secondary endpoints were the emergence of vancomycin-resistant enterococci, vancomycin-intermediate S. aureus and vancomycin consumption. A total of 84 patients, admitted to a medical\\/surgical ICU and mechanically ventilated for w72

L. Silvestri; H. K. F. van Saene; M. Milanese; F. Fontana; D. Gregoriz; L. Oblach; N. Piacente; M. Blazic

2004-01-01

297

Community-associated methicillin-resistant Staphylococcus aureus (MRSA) in Australia  

Microsoft Academic Search

A series of epidemics of community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) have occurred in Australia, starting in Western Australia in the early 1990s, in the Northern Territory soon thereafter and in eastern states in the mid 1990s. The Western Australian epidemic has been due mainly to Panton–Valentine leukocidin (PVL)-negative clones, whilst PVL-positive clones have predominated in the east. More recently, the

Graeme R. Nimmo; Geoffrey W. Coombs

2008-01-01

298

Determination of the antibiofilm, antiadhesive, and anti-MRSA activities of seven Salvia species  

PubMed Central

Background: Several Salvia species are indigenous to Jordan and are widely used as beverages and spices and for their medicinal properties. The objective of the study was to establish the antimicrobial activities, including the antiadhesive and antibiofilm effects of seven different Salvia species. Materials and Methods: Methods used for planktonic culture included agar diffusion, broth microdilution, and minimal biocidal concentration determination while viable count was used for the determination of the antibiofilm and antiadhesion activities. Overnight cultures of reference strains of Candida albicans, Escherichia coli, Pseudomonas aeruginosa, and Staphylococcus aureus and clinical strains of methicillin-resistant S. aureus (MRSA) were used as test microorganisms. Results: An antimicrobial activity toward planktonic cultures demonstrated a significant bacteriocidal activity (?4 log cycle reduction) for the S. triloba extract against S. aureus including MRSA. Its volatile oil exhibited an antimicrobial activity covering all tested microorganisms with the exception of P. aeruginosa. S. triloba extract and volatile oil were successful in preventing and controlling the biofilm, demonstrating antiadhesion and antibiofilm activities, respectively. Conclusion: These reported activities for S. triloba extract and volatile oil allows their listing as potential antibiofilm and anti-MRSA natural agents. This might suggest their use as an antiseptic in the prophylaxis and treatment of S. aureus-associated skin infections. The antimicrobial activity of the other tested Salvia species was negligible.

Al-Bakri, Amal G.; Othman, Ghadeer; Afifi, Fatma U.

2010-01-01

299

Exploration of the activity of 7-pyrrolidino-8-methoxyisothiazoloquinolones against methicillin-resistant Staphylococcus aureus (MRSA).  

PubMed

A series of 7-(3'-substituted)pyrrolidino-8-methoxyisothiazoloquinolone (ITQ) analogues were prepared, and their antibacterial potency against methicillin-sensitive Staphylococcus aureus (MSSA), methicillin-resistant Staphylococcus aureus (MRSA), and Escherichia coli were compared. Many of these analogues had MIC ? 0.25 ?g/mL against quinolone-resistant MRSA strains. The stereochemical preference was explored for a series of 1''-methyl-3'-aminomethylpyrrolidine analogues. Antibacterial activity was generally more favorable with 3'-R, 1''-S configuration. Substitution on the 3'-aminomethyl nitrogen tended to decrease activity, while potency was maintained with disubstitution or aryl substitution at the 1''-carbon. The 7-[(R)-3-((S)-1-aminoethyl)pyrrolidin-1-yl] analogue (6a(R,S)) and the (R)-7-[3-(2-aminopropan-2-yl)pyrrolidin-1-yl] analogue (7a(R)) were found to be the ITQs with the most promising antibacterial profiles. The MICs of these select ITQs versus a panel of clinical MRSA strains were determined, and the ITQs were found to have 8- to 16-fold greater potency than linezolid. These analogues were also evaluated for inhibition of the target enzymes, topoisomerase IV and DNA gyrase, from both wild-type and multidrug resistant strains. The ITQs were up to >30 times more inhibitory against these targets than the fluoroquinolone moxifloxacin. PMID:21425851

Kim, Ha Young; Wiles, Jason A; Wang, Qiuping; Pais, Godwin C G; Lucien, Edlaine; Hashimoto, Akihiro; Nelson, David M; Thanassi, Jane A; Podos, Steven D; Deshpande, Milind; Pucci, Michael J; Bradbury, Barton J

2011-05-12

300

Methicillin-resistant Staphylococcus aureus (MRSA)-active metabolites from Platanus occidentalis (American Sycamore).  

PubMed

One known and three new potent, selective, and nontoxic anti-MRSA metabolites, kaempferol 3-O-alpha-l-(2'',3''-di-E-p-coumaroyl)rhamnoside (1) (IC(50) 2.0 microg/mL), kaempferol 3-O-alpha-l-(2''-E-p-coumaroyl-3''-Z-p-coumaroyl)rhamnoside (2) (IC(50) 0.8 microg/mL), kaempferol 3-O-alpha-l-(2''-Z-p-coumaroyl-3''-E-p-coumaroyl)rhamnoside (3) (IC(50) 0.7 microg/mL), and kaempferol 3-O-alpha-l-(2'',3''-di-Z-p-coumaroyl)rhamnoside (4) (IC(50) 0.4 microg/mL), were isolated from the leaves of the common American sycamore, Platanus occidentalis. Compounds 2-4 are new. Due to the unusual selectivity, potency, and safety of the pure compounds and the semipure glycoside mixture against MRSA, it is clear that this represents a viable class of inhibitors to prevent growth of MRSA on surfaces and systemically. PMID:19904995

Ibrahim, Mohamed A; Mansoor, Arsala A; Gross, Amanda; Ashfaq, M Khalid; Jacob, Melissa; Khan, Shabana I; Hamann, Mark T

2009-12-01

301

Control of spread of Methicillin Resistant Staphylococcus aureus (MRSA) in Burns Units.  

PubMed

Results of four years' studies from a number of hospitals in Kenya have shown that nosocomial infections in burns units are due to Methicillin Resistant Staphylococcus aureus (MRSA). Through chromosomal DNA and plasmid DNA, the stain is highly resistant to sulphonamide ointment and other antibiotics. 90% of patients admitted in burns units get colonized or infected with MRSA. The strain prolongs the duration of patients in hospitals. The burns degenerate to second and third degree burns, thereby necessitating skin grafting. The environment has been found to be contaminated with this strain with some staff members having chronic throat infections. Minocycline was found to be effective in treating the infected staff members. Cleaning this environment with Sodium dichloroisocyanurate (precepts)/Sodium hypochlorite (JIK) reduced drastically the mechanical transmission of bacteria in the units. The duration of stay of the patient was reduced. This shows that MRSA which is spread in government and private hospitals can cheaply be controlled by the proper use of disinfectants, antiseptics, and use of effective antibiotics when necessary. PMID:12160450

Muthotho, James N.; Waiyaki, Peter G.; Mbalu, Michael; Wairugu, Anne; Mwanthi, Beth; Odongo, Ben

1995-02-01

302

Otolaryngologic community-acquired MRSA infections in a suburban private practice.  

PubMed

A retrospective review was conducted of all cases of head and neck community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) infections seen in the senior author's suburban private practice during a 12-month period. An office and hospital chart review was performed for all patients identified with culture-positive CA-MRSA infections. Several parameters were evaluated, including site of infection, prior therapy, imaging, comorbid disease, culture and sensitivities, surgical and medical management, and long-term results. Of the 10 patients identified, 3 had infections of nasal soft tissues, 3 had infections of the lips, 2 had infections of the paranasal sinus, 1 had an infection of the chin, and 1 had a diffuse, hemifacial infection. All patients were managed successfully with a combination of surgical drainage, wound care, and antibiotics. CA-MRSA is a burgeoning problem in otolaryngology. Appropriate management-including early recognition, appropriate empirical therapy, prompt and thorough surgical drainage with culture and sensitivities, correct antibiotic choice, and meticulous postoperative care-appears to offer excellent results. PMID:20981651

Shaw, Gary Y; Montandon, Shari V; Driks, Michael R

2010-10-01

303

Prevalence of livestock-associated MRSA in broiler flocks and risk factors for slaughterhouse personnel in The Netherlands.  

PubMed

To determine methicillin-resistant Staphylococcus aureus (MRSA) carriage in poultry and slaughterhouse personnel, 40 Dutch broiler flocks, in six slaughterhouses and 466 personnel were sampled. Of the employees, 26 were positive (5.6%), indicating a higher risk of exposure when compared to the general Dutch population (0.1%). This risk was significantly higher for personnel having contact with live animals (5.2%) - especially hanging broilers on the slaughterline (20.0%) - than for all other personnel (1.9%). Conventional electric stunning conferred a significantly higher risk of MRSA carriage for employees than CO2 stunning (9.7% vs. 2.0%). A total of 405 broilers were sampled upon their arrival at the slaughterhouse, of which 6.9% were positive. These broilers originated from 40 Dutch slaughter flocks of which 35.0% were positive. MRSA contamination in the different compartments of slaughterhouses increased during the production day, from 8% to 35%. Of the 119 MRSA isolates, predominantly livestock-associated MRSA ST398 was found, although 27.7% belonged to ST9 (spa type t1430). There is an increased risk of MRSA carriage in personnel working at broiler slaughterhouses, particularly those having contact with live animals. PMID:20109255

Mulders, M N; Haenen, A P J; Geenen, P L; Vesseur, P C; Poldervaart, E S; Bosch, T; Huijsdens, X W; Hengeveld, P D; Dam-Deisz, W D C; Graat, E A M; Mevius, D; Voss, A; Van De Giessen, A W

2010-05-01

304

The Nonantibiotic Small Molecule Cyslabdan Enhances the Potency of ?-Lactams against MRSA by Inhibiting Pentaglycine Interpeptide Bridge Synthesis  

PubMed Central

The nonantibiotic small molecule cyslabdan, a labdan-type diterpene produced by Streptomyces sp. K04-0144, markedly potentiated the activity of the ?-lactam drug imipenem against methicillin-resistant Staphylococcus aureus (MRSA). To study the mechanism of action of cyslabdan, the proteins that bind to cyslabdan were investigated in an MRSA lysate, which led to the identification of FemA, which is involved in the synthesis of the pentaglycine interpeptide bridge of the peptidoglycan of MRSA. Furthermore, binding assay of cyslabdan to FemB and FemX with the function similar to FemA revealed that cyslabdan had an affinity for FemB but not FemX. In an enzyme-based assay, cyslabdan inhibited FemA activity, where as did not affected FemX and FemB activities. Nonglycyl and monoglycyl murein monomers were accumulated by cyslabdan in the peptidoglycan of MRSA cell walls. These findings indicated that cyslabdan primarily inhibits FemA, thereby suppressing pentaglycine interpeptide bridge synthesis. This protein is a key factor in the determination of ?-lactam resistance in MRSA, and our findings provide a new strategy for combating MRSA.

Koyama, Nobuhiro; Tokura, Yuriko; Munch, Daniela; Sahl, Hans-Georg; Schneider, Tanja; Shibagaki, Yoshio; Ikeda, Haruo; Tomoda, Hiroshi

2012-01-01

305

Effectiveness of Hospital-Wide Methicillin-Resistant Staphylococcus aureus (MRSA) Infection Control Policies Differs by Ward Specialty  

PubMed Central

Methicillin-resistant Staphylococcus aureus (MRSA) is a major cause of preventable nosocomial infections and is endemic in hospitals worldwide. The effectiveness of infection control policies varies significantly across hospital settings. The impact of the hospital context towards the rate of nosocomial MRSA infections and the success of infection control is understudied. We conducted a modelling study to evaluate several infection control policies in surgical, intensive care, and medical ward specialties, each with distinct ward conditions and policies, of a tertiary public hospital in Sydney, Australia. We reconfirm hand hygiene as the most successful policy and find it to be necessary for the success of other policies. Active screening for MRSA, patient isolation in single-bed rooms, and additional staffing were found to be less effective. Across these ward specialties, MRSA transmission risk varied by 13% and reductions in the prevalence and nosocomial incidence rate of MRSA due to infection control policies varied by up to 45%. Different levels of infection control were required to reduce and control nosocomial MRSA infections for each ward specialty. Infection control policies and policy targets should be specific for the ward and context of the hospital. The model we developed is generic and can be calibrated to represent different ward settings and pathogens transmitted between patients indirectly through health care workers. This can aid the timely and cost effective design of synergistic and context specific infection control policies.

Sadsad, Rosemarie; Sintchenko, Vitali; McDonnell, Geoff D.; Gilbert, Gwendolyn L.

2013-01-01

306

Controlling methicillin-resistant Staphylococcus aureus (MRSA) in a hospital and the role of hydrogen peroxide decontamination: an interrupted time series analysis  

PubMed Central

Objectives The impact of surface disinfection versus detergent cleaning on healthcare associated infection rates remains unresolved. We aimed to evaluate the efficacy of hydrogen peroxide (HP) decontamination against methicillin-resistant Staphylococcus aureus (MRSA). Design Single centred retrospective before and after study design. Setting Launceston General Hospital, Tasmania, Australia. Participants Patients with MRSA infection or colonisation. Interventions Rooms occupied by patients with MRSA infection or colonisation were cleaned following discharge with either detergent or HP. Main outcome measures MRSA room contamination following cleaning; new MRSA acquisition in patients. Results Over 3600 discharge cleans were completed, with more than 32?600 environmental swabs processed. MRSA was isolated from 24.7% rooms following detergent cleaning and from 18.8% of rooms after HP (p<0.001). The incidence of MRSA acquisition reduced from 9.0 to 5.3 per 10?000 patient days in detergent and disinfectant arms, respectively (p<0.001). Conclusions Use of HP disinfection led to a decrease in residual MRSA contamination in patient rooms compared with detergent. It may also have encouraged the reduction in patient MRSA acquisition despite several confounders including staff feedback on terminal cleaning, additional MRSA screening and quicker laboratory methods. Infection control is best served by concurrent interventions targeting both the patient and healthcare environment.

Mitchell, Brett G; Digney, Wilhelmine; Locket, Phil; Dancer, Stephanie J

2014-01-01

307

Traditional Chinese medicine for atopic eczema: PentaHerbs formula suppresses inflammatory mediators release from mast cells  

Microsoft Academic Search

BackgroundPentaHerbs formula (PHF) containing Cortex Moutan, root bark of Paeonia suffruticosa Andr. (Ranunculaceae), Cortex Phellodendri, bark of Phellodendron chinensis Schneid. (Rutaceae), Flos Lonicerae, flower of Lonicera japonica Thunb. (Capri-foliaceae), Herba Menthae, aerial part of Mentha haplocalyx Briq. (Labiatae) and Rhizoma Atractylodis, rhizome of Atractylodes lancea (Thunb.) DC. (Compositae) at the ratio of 2:2:2:1:2 was useful in the management of eczema.

Ben Chung Lap Chan; Kam Lun Ellis Hon; Ping Chung Leung; Sze Wing Sam; Kwok Pui Fung; Mavis Yuk Ha Lee; Hang Yung Alaster Lau

2008-01-01

308

Increased Expression of RANTES, CCR3 and CCR5 in the Lesional Skin of Patients with Atopic Eczema  

Microsoft Academic Search

Background: Atopic eczema (AE) is a relapsing inflammatory disease based on IgE sensitization and characterized by peripheral blood eosinophilia and eosinophil infiltration into the lesional skin. In the patch test reaction of AE by allergens, an increased infiltration of activated eosinophils has been demonstrated peaking at 24–48 h. Regulated on activation normal T cell expressed and secreted (RANTES\\/CCL5) is a

Yoko Kato; Ruby Pawankar; Yoichi Kimura; Seiji Kawana

2006-01-01

309

Prospective Registration and Outcome-Reporting Bias in Randomized Controlled Trials of Eczema Treatments: A Systematic Review  

PubMed Central

We assessed completeness of trial registration and the extent of outcome-reporting bias in published randomized controlled trials (RCTs) of eczema (atopic dermatitis) treatments by surveying all relevant RCTs published from January 2007 to July 2011 located in a database called the Global Resource of Eczema Trials (GREAT). The GREAT database is compiled by searching six bibliographic databases, including EMBASE and MEDLINE. Out of 109 identified RCTs, only 37 (34%) had been registered on an approved trial register. Only 18 out of 109 trials (17%) had been registered “properly” in terms of submitting the registration before the trial end date and nominating a primary outcome. The proportion of “any registered” and “properly registered” RCTs increased from 19% and 10% in 2007 to 57% and 36% in 2011, respectively. Assessment of selective outcome-reporting bias was difficult even among the properly registered trials owing to unclear primary outcome description especially with regard to timing. Only 5 out of the 109 trials (5%) provided enough information for us to be confident that the outcomes reported in the published trial were consistent with the original registration. Adequate trial registration and description of primary outcomes for eczema RCTs is currently poor.

Nankervis, Helen; Baibergenova, Akerke; Williams, Hywel C; Thomas, Kim S

2012-01-01

310

Exposure to ambient ultrafine particles and urinary 8-hydroxyl-2-deoxyguanosine in children with and without eczema.  

PubMed

Ambient fine and ultrafine particles (UFPs) in urban air are known to contribute to inflammatory and allergic disease. It has been suggested that oxidative stress is an underlying mechanism for the detrimental health effects. The objective of this study was to investigate the short-term effect of ambient UFPs and particulate polycyclic aromatic hydrocarbons (PAHs) on urinary 8-hydroxyl-2-deoxyguanosine (8-OHdG) concentrations in children with and without eczema. Spot urine samples were collected from 84 children twice weekly for 61 days and 8-OHdG content was measured. Significant associations were found between the ambient UFPs and particle bound PAHs and increase in urinary 8-OHdG levels. An inter-quartile range (IQR) increase in the UFP concentration in the 24-h (IQR, 32,300/m(3)) period preceding urine collection was significantly associated with a 5.7% (95% confidence interval [CI], 0.16-1.27%) increase in the urinary 8-OHdG level children with AD. In children without eczema, such short-term effect of previous day UFPs on urinary 8-OHdG was not observed. There were no significant positive associations between the mass fraction of PMs and urinary 8-OHdG. The results suggest that short-term exposure to ambient UFPs plays a critical role in PM induced oxidative stress in children with eczema. PMID:23685365

Song, Sanghwan; Paek, Domyung; Park, Chunghee; Lee, Chulwoo; Lee, Jung-Hyun; Yu, Seung-Do

2013-08-01

311

Pharmacodynamics of vancomycin at simulated epithelial lining fluid concentrations against methicillin-resistant Staphylococcus aureus (MRSA): implications for dosing in MRSA pneumonia.  

PubMed

Little is known regarding killing activity of vancomycin against methicillin (meticillin)-resistant Staphylococcus aureus (MRSA) in pneumonia since the extent of vancomycin penetration into epithelial lining fluid (ELF) has not been definitively established. We evaluated the impact of the extent of ELF penetration on bacterial killing and resistance by simulating a range of vancomycin exposures (24-h free drug area under the concentration-time curve [fAUC24]/MIC) using an in vitro pharmacodynamic model and population-based mathematical modeling. A high-dose, 1.5-g-every-12-h vancomycin regimen according to American Thoracic Society/Infectious Diseases Society of America guidelines (trough concentration, 15 mg/liter) with simulated ELF/plasma penetration of 0, 20, 40, 60, 80, or 100% (fAUC24/MIC of 0, 70, 140, 210, 280, or 350) was evaluated against two agr-functional, group II MRSA clinical isolates obtained from patients with a bloodstream infection (MIC = 1.0 mg/liter) at a high inoculum of 10(8) CFU/ml. Despite high vancomycin exposures and 100% penetration, all regimens up to a fAUC24/MIC of 350 did not achieve bactericidal activity. At regimens of < or = 60% penetration (fAUC24/MIC < or = 210), stasis and regrowth occurred, amplifying the development of intermediately resistant subpopulations. Regimens simulating > or = 80% penetration (fAUC24/MIC > or = 280) suppressed development of resistance. Resistant mutants amplified by suboptimal vancomycin exposure displayed reduced rates of autolysis (Triton X-100) at 72 h. Bacterial growth and death were well characterized by a Hill-type model (r2 > or = 0.984) and a population pharmacodynamic model with a resistant and susceptible subpopulation (r2 > or = 0.965). Due to the emergence of vancomycin-intermediate resistance at a fAUC24/MIC of < or = 210, exceeding this exposure breakpoint in ELF may help to guide optimal dosage regimens in the treatment of MRSA pneumonia. PMID:19596879

Harigaya, Yoriko; Bulitta, Jürgen B; Forrest, Alan; Sakoulas, George; Lesse, Alan J; Mylotte, Joseph M; Tsuji, Brian T

2009-09-01

312

Variants of the FADS1 FADS2 Gene Cluster, Blood Levels of Polyunsaturated Fatty Acids and Eczema in Children within the First 2 Years of Life  

PubMed Central

Background Association of genetic-variants in the FADS1-FADS2-gene-cluster with fatty-acid-composition in blood of adult-populations is well established. We analyze this genetic-association in two children-cohort-studies. In addition, the association between variants in the FADS-gene-cluster and blood-fatty-acid-composition with eczema was studied. Methods and Principal Findings Data of two population-based-birth-cohorts in the Netherlands and Germany (KOALA, LISA) were pooled (n?=?879) and analyzed by (logistic) regression regarding the mutual influence of single-nucleotide-polymorphisms (SNPs) in the FADS-gene-cluster (rs174545, rs174546, rs174556, rs174561, rs3834458), on polyunsaturated fatty acids (PUFA) in blood and parent-reported eczema until the age of 2 years. All SNPs were highly significantly associated with all PUFAs except for alpha-linolenic-acid and eicosapentaenoic-acid, also after correction for multiple-testing. All tested SNPs showed associations with eczema in the LISA-study, but not in the KOALA-study. None of the PUFAs was significantly associated with eczema neither in the pooled nor in the analyses stratified by study-cohort. Conclusions and Significance PUFA-composition in young children's blood is under strong control of the FADS-gene-cluster. Inconsistent results were found for a link between these genetic-variants with eczema. PUFA in blood was not associated with eczema. Thus the hypothesis of an inflammatory-link between PUFA and eczema by the metabolic-pathway of LC-PUFAs as precursors for inflammatory prostaglandins and leukotrienes could not be confirmed by these data.

Rzehak, Peter; Thijs, Carel; Standl, Marie; Mommers, Monique; Glaser, Claudia; Jansen, Eugene; Klopp, Norman; Koppelman, Gerard H.; Singmann, Paula; Postma, Dirkje S.; Sausenthaler, Stefanie; Dagnelie, Pieter C.; van den Brandt, Piet A.; Koletzko, Berthold; Heinrich, Joachim

2010-01-01

313

Evaluation of single and double-locus real-time PCR assays for methicillin-resistant Staphylococcus aureus (MRSA) surveillance  

PubMed Central

Background Methicillin-resistant Staphylococcus aureus (MRSA) is a human pathogen, representing an infection control challenge. Conventional MRSA screening takes up to three days, therefore development of rapid detection is essential. Real time-PCR (rt-PCR) is the fastest method fulfilling this task. All currently published or commercially available rt-PCR MRSA assays relay on single or double-locus detection. Double-locus assays are based on simultaneous detection of mecA gene and a S. aureus-specific gene. Such assays cannot be applied on clinical samples, which often contain both coagulase-negative staphylococci (CoNS) and S. aureus, either of which can carry mecA. Single-locus assays are based on detection of the staphylococcal cassette chromosome mec (SCCmec) element and the S. aureus-specific orfX gene, assuming that it is equivalent to mecA detection. Findings Parallel evaluation of several published single and double-locus rt-PCR MRSA assays of 150 pure culture strains, followed by analysis of 460 swab-derived clinical samples which included standard identification, susceptibility testing, followed by PCR detection of staphylococcal suspected isolates and in-PCR mixed bacterial populations analysis indicated the following findings. Pure cultures analysis indicated that one of the single-locus assay had very high prevalence of false positives (Positive predictive value = 77.8%) and was excluded from further analysis. Analysis of 460 swab-derived samples indicated that the second single-locus assay misidentified 16 out of 219 MRSA's and 13 out of 90 methicillin-sensitive S. aureus's (MSSA) were misidentified as MRSA's. The double-locus detection assay misidentified 55 out of 90 MSSA's. 46 MSSA containing samples were misidentified as MRSA and 9 as other than S. aureus ending with low positive predicted value (<85%) and very low specificity (<62%). Conclusion The results indicate that high prevalence of false-positive and false-negative reactions occurs in such assays.

2010-01-01

314

Rapid and robust phylotyping of spa t003, a dominant MRSA clone in Luxembourg and other European countries  

PubMed Central

Background spa typing is a common genotyping tool for methicillin-resistant Staphylococcus aureus (MRSA) in Europe. Given the high prevalence of dominant clones, spa-typing is proving to be limited in its ability to distinguish outbreak isolates from background isolates. New molecular tools need to be employed to improve subtyping of dominant local MRSA strains (e.g., spa type t003). Methods Phylogenetically critical, or canonical, SNPs (can-SNPs) were identified as subtyping targets through sequence analysis of 40 MRSA whole genomes from Luxembourg. Real-time PCR assays were designed around target SNPs and validated using a repository of 240 previously sub-typed and epidemiologically characterized Luxembourg MRSA isolates, including 153 community and hospital isolates, 69 isolates from long term care (LTC) facilities, and 21 prospectively analyzed MRSA isolates. Selected isolates were also analyzed by whole genome SNP typing (WGST) for comparison to the SNP assays and other subtyping techniques. Results Fourteen real-time PCR assays were developed and validated, including two assays to determine presence of spa t003 or t008. The other twelve assays successfully provided a high degree of resolution within the t003 subtype. WGST analysis of the LTC facility isolates provided greater resolution than other subtyping tools, identifying clusters indicative of ongoing transmission within LTC facilities. Conclusions canSNP-based PCR assays are useful for local level MRSA phylotyping, especially in the presence of one or more dominant clones. The assays designed here can be easily adapted for investigating t003 MRSA strains in other regions in Western Europe. WGST provides substantially better resolution than other typing methods.

2013-01-01

315

Characterization of beta-lactam antibiotic-induced vancomycin-resistant MRSA (BIVR) in a patient with septicemia during long-term vancomycin administration.  

PubMed

It was reported that some methicillin-resistant Staphylococcus aureus (MRSA) show resistance to vancomycin (VCM) and beta-lactam antibiotics; thus, they are termed beta-lactam antibiotic-induced VCM-resistant MRSA (BIVR). The VCM resistance of MRSA is induced by the administration of beta-lactam antibiotics, but this phenomenon can be difficult to detect in the clinical laboratory. We detected the BIVR strain in a 64-year-old man who had had a ventilator tube inserted directly into the windpipe during long-term VCM therapy. The patient was diagnosed with MRSA pneumonia and septicemia on July 5, 2007, and sulbactam/ampicillin (SBT/ABPC) was administered for 5 days. However, the fever recurred, and administration of VCM was resumed for 7 days from July 19. Fever developed again, and VCM was administered again for 14 days from September 30. BIVR and VCM-low-sensitive MRSA were isolated from blood on October 18 and 22, although the VCM trough concentration was 10.2 microg/ml. On October 27, we changed to a combination of fosfomycin (FOM) and arbekacin (ABK), and thereafter the fever quickly decreased and the clinical symptoms abated. We isolated five MRSA strains from the blood of the patient, three strains of VCM-sensitive MRSA, one strain of BIVR, and one strain of a VCM-low-sensitive MRSA. The DNA band patterns determined by pulsed-field gel electrophoresis were completely identical except for the VCM-low-sensitive MRSA, which was missing one band. Furthermore, the VCM-low-sensitive MRSA became sensitive to beta-lactam antibiotics. Our results indicate the possibility that long-term VCM therapy is one of the factors that allow BIVR or VCM-low-sensitive MRSA to emerge, and this allows VCM therapy for MRSA to fail. PMID:19856063

Yamaguchi, Yoshio; Hanaki, Hideaki; Yanagisawa, Chie; Ikeda-Dantsuji, Yurika; Hashimoto, Takeo; Yazaki, Harunori; Sugahara, Keiko; Yanagisawa, Takashi; Kawajiri, Hiroki; Sato, Shizue; Ishizaki, Aki; Tachihara-Sato, Rika; Takahashi, Yasuhisa; Ono, Taro; Kageyama, Yo; Kawaguchi, Tomohumi; Tamura, Akihiko; Hagane, Kazuhiko; Sunakawa, Keisuke

2009-10-01

316

Methicillin Resistant Staphylococcus aureus ST398 in Veal Calf Farming: Human MRSA Carriage Related with Animal Antimicrobial Usage and Farm Hygiene  

Microsoft Academic Search

IntroductionRecently a specific MRSA sequence type, ST398, emerged in food production animals and farmers. Risk factors for carrying MRSA ST398 in both animals and humans have not been fully evaluated. In this cross-sectional study, we investigated factors associated with MRSA colonization in veal calves and humans working and living on these farms.MethodsA sample of 102 veal calf farms were randomly

Haitske Graveland; Jaap A. Wagenaar; Hans Heesterbeek; Dik Mevius; Engeline van Duijkeren; Dick Heederik; Michael Otto

2010-01-01

317

Increased rifampicin resistance in blood isolates of meticillin-resistant Staphylococcus aureus (MRSA) amongst patients exposed to rifampicin-containing antituberculous treatment  

Microsoft Academic Search

The aim of this study was to determine the rifampicin (RIF) resistance rate of meticillin-resistant Staphylococcus aureus (MRSA) amongst patients with MRSA bacteraemia who have or have not been exposed to RIF-containing antituberculous (anti-TB) treatment. From 2000 to 2008, patients with MRSA bacteraemia and previous exposure to RIF-containing anti-TB therapy were selected. Patients matched for sex, age and time of

Che-Kim Tan; Chih-Cheng Lai; Chun-Hsing Liao; Sheng-Hsiang Lin; Yu-Tsung Huang; Po-Ren Hsueh

2011-01-01

318

Prevalence of livestock-associated MRSA on Dutch broiler farms and in people living and/or working on these farms.  

PubMed

This study aimed to determine the prevalence and risk factors for methicillin-resistant Staphylococcus aureus (MRSA) on 50 Dutch broiler farms. Of 145 persons living and/or working on these farms, eight tested positive for MRSA (5.5%). Investigation of 250 pooled throat samples of broilers and 755 dust samples resulted in four farms where MRSA-positive samples were present (8.0%). All isolates belonged to the CC398 complex. Living and/or working on a MRSA-positive farm was a risk for MRSA carriage; 66.7% of people on positive farms were MRSA positive vs. 1.5% on negative farms (P<0.0001). Due to the low number of positive farms and persons, and high similarity in farm management, it was impossible to draw statistically valid conclusions on other risk factors. For broiler farming, both farm and human MRSA prevalence seem much lower than for pig or veal farming. However, MRSA carriage in people living and/or working on broiler farms is higher compared to the general human population in The Netherlands (5.5% vs. <0.1%). As broiler husbandry systems are not unique to The Netherlands, this might imply that people in contact with live broilers are at risk for MRSA carriage worldwide. PMID:22831886

Geenen, P L; Graat, E A M; Haenen, A; Hengeveld, P D; Van Hoek, A H A M; Huijsdens, X W; Kappert, C C; Lammers, G A C; Van Duijkeren, E; Van De Giessen, A W

2013-05-01

319

Genetic Variation in Spatio-Temporal Confined USA300 Community-Associated MRSA Isolates: A Shift from Clonal Dispersion to Genetic Evolution?  

PubMed Central

Introduction Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) are increasingly isolated, with USA300-0114 being the predominant clone in the USA. Comparative whole genome sequencing of USA300 isolates collected in 2002, 2003 and 2005 showed a limited number of single nucleotide polymorphisms and regions of difference. This suggests that USA300 has undergone rapid clonal expansion without great genomic diversification. However, whole genome comparison of CA-MRSA has been limited to isolates belonging to USA300. The aim of this study was to compare the genetic repertoire of different CA-MRSA clones with that of HA-MRSA from the USA and Europe through comparative genomic hybridization (CGH) to identify genetic clues that may explain the successful and rapid emergence of CA-MRSA. Materials and Methods Hierarchical clustering based on CGH of 48 MRSA isolates from the community and nosocomial infections from Europe and the USA revealed dispersed clustering of the 19 CA-MRSA isolates. This means that these 19 CA-MRSA isolates do not share a unique genetic make-up. Only the PVL genes were commonly present in all CA-MRSA isolates. However, 10 genes were variably present among 14 USA300 isolates. Most of these genes were present on mobile elements. Conclusion The genetic variation present among the 14 USA300 isolates is remarkable considering the fact that the isolates were recovered within one month and originated from a confined geographic area, suggesting continuous evolution of this clone.

Carpaij, Neeltje; Willems, Rob J. L.; Rice, Thomas W.; Weinstein, Robert A.; Hinds, Jason; Witney, Adam A.; Lindsay, Jodi A.; Bonten, Marc J. M.; Fluit, Ad C.

2011-01-01

320

Towards genomic selection for facial eczema disease tolerance in the New Zealand sheep industry.  

PubMed

Pithomycotoxicosis, more commonly known as facial eczema (FE), is a liver disease that occurs predominantly in New Zealand because of its toxigenic Pithomyces chartarum strains. The first reported case was in sheep in 1887. Since the 1930s, a number of studies have been conducted in an attempt to mitigate the problems FE has on the sheep and dairy industries. The research in these studies included work on fungicide and biological control of the saprophytic fungus, use of different pasture plants to inhibit fungal growth, stock management with respect to pasture fungal spore counts and the use of zinc prophylaxis on animals. The finding that there was a genetic basis in FE sensitivity in sheep prompted research for a genetic approach to mitigation in the form of a diagnostic DNA test for susceptibility to the disease. Recently, we have used the Illumina OvineSNP50 BeadChip to develop a genome-enabled prediction approach to screen for FE-tolerant sheep. Our current best genomic prediction for FE is for the Romney breed and has an accuracy of 0.38. This prediction accuracy is not as high as the individual accuracy gained by an artificial challenge test (0.64). However, it has the advantage of being a non-invasive test and can be provided as part of genomic testing for other traits at minimal cost. PMID:24804852

Phua, S H; Hyndman, D L; Baird, H J; Auvray, B; McEwan, J C; Lee, M A; Dodds, K G

2014-08-01

321

An evidence-based review of linezolid for the treatment of methicillin-resistant Staphylococcus aureus (MRSA): place in therapy  

PubMed Central

Methicillin-resistant Staphylococcus aureus (MRSA), including community-associated and hospital-associated strains, is a major cause of human morbidity and mortality. Treatment options have become limited due to the emergence of MRSA strains with decreased sensitivity to vancomycin, which has long been the first-line therapy for serious infections. This has prompted the search for novel antibiotics that are efficacious against MRSA. Linezolid, an oxazolidinone class of antibiotic, was approved by the Food and Drug Administration in 2000 for treatment of MRSA infections. Since then, there have been a multitude of clinical trials and research studies evaluating the effectiveness of linezolid against serious infections, including pneumonia (both community- and hospital-acquired), skin and soft-tissue infections such as diabetic foot ulcers, endocarditis, osteomyelitis, prosthetic devices, and others. The primary aim of this review is to provide an up-to-date evaluation of the clinical evidence for using linezolid to treat MRSA infections, with a focus on recently published studies, including those on nosocomial pneumonia. Other objectives are to analyze the cost-effectiveness of linezolid compared to other agents, and to review the pharmokinetics and pharmacodynamics of linezolid, emphasizing the most current concepts.

Watkins, Richard R; Lemonovich, Tracy L; File, Thomas M

2012-01-01

322

Induction of MRSA Biofilm by Low-Dose ?-Lactam Antibiotics: Specificity, Prevalence and Dose-Response Effects  

PubMed Central

Methicillin-resistant Staphylococcus aureus (MRSA) is a leading cause of hospital- and community-associated infections. The formation of adherent clusters of cells known as biofilms is an important virulence factor in MRSA pathogenesis. Previous studies showed that subminimal inhibitory (sub-MIC) concentrations of methicillin induce biofilm formation in the community-associated MRSA strain LAC. In this study we measured the ability sub-MIC concentrations of eight other ?-lactam antibiotics and six non-?-lactam antibiotics to induce LAC biofilm. All eight ?-lactam antibiotics, but none of the non-?-lactam antibiotics, induced LAC biofilm. The dose-response effects of the eight ?-lactam antibiotics on LAC biofilm varied from biphasic and bimodal to near-linear. We also found that sub-MIC methicillin induced biofilm in 33 out of 39 additional MRSA clinical isolates, which also exhibited biphasic, bimodal and linear dose-response curves. The amount of biofilm formation induced by sub-MIC methicillin was inversely proportional to the susceptibility of each strain to methicillin. Our results demonstrate that induction of biofilm by sub-MIC antibiotics is a common phenotype among MRSA clinical strains and is specific for ?-lactam antibiotics. These findings may have relevance to the use of ?-lactam antibiotics in clinical and agricultural settings.

Ng, Mandy; Epstein, Samuel B.; Callahan, Mary T.; Piotrowski, Brian O.; Simon, Gary L.; Roberts, Afsoon D.; Keiser, John F.; Kaplan, Jeffrey B.

2014-01-01

323

Induction of MRSA Biofilm by Low-Dose ?-Lactam Antibiotics: Specificity, Prevalence and Dose-Response Effects.  

PubMed

Methicillin-resistant Staphylococcus aureus (MRSA) is a leading cause of hospital- and community-associated infections. The formation of adherent clusters of cells known as biofilms is an important virulence factor in MRSA pathogenesis. Previous studies showed that subminimal inhibitory (sub-MIC) concentrations of methicillin induce biofilm formation in the community-associated MRSA strain LAC. In this study we measured the ability sub-MIC concentrations of eight other ?-lactam antibiotics and six non-?-lactam antibiotics to induce LAC biofilm. All eight ?-lactam antibiotics, but none of the non-?-lactam antibiotics, induced LAC biofilm. The dose-response effects of the eight ?-lactam antibiotics on LAC biofilm varied from biphasic and bimodal to near-linear. We also found that sub-MIC methicillin induced biofilm in 33 out of 39 additional MRSA clinical isolates, which also exhibited biphasic, bimodal and linear dose-response curves. The amount of biofilm formation induced by sub-MIC methicillin was inversely proportional to the susceptibility of each strain to methicillin. Our results demonstrate that induction of biofilm by sub-MIC antibiotics is a common phenotype among MRSA clinical strains and is specific for ?-lactam antibiotics. These findings may have relevance to the use of ?-lactam antibiotics in clinical and agricultural settings. PMID:24659939

Ng, Mandy; Epstein, Samuel B; Callahan, Mary T; Piotrowski, Brian O; Simon, Gary L; Roberts, Afsoon D; Keiser, John F; Kaplan, Jeffrey B

2014-01-01

324

Use of the antimicrobial peptide Epinecidin-1 to protect against MRSA infection in mice with skin injuries.  

PubMed

Methicillin-resistant Staphylococcus aureus (MRSA) causes infections through open skin injuries, and its resistance makes treatment difficult. The antimicrobial peptide Epinecidin-1 (Epi-1) has been reported to possess antibacterial, antifungal, antiviral, and antitumor functions. This study investigated the antimicrobial activity of Epi-1 against skin trauma-mediated MRSA infection in mice. One square centimeter of outer skin was excised from the ventral region of mice, and a lethal dose of MRSA was applied in the presence or absence of methicillin, vancomycin, or Epi-1. While untreated mice and mice treated with methicillin died within four days, mice treated with Epi-1 survived infection. Epi-1 decreased MRSA bacterial counts in the wounded region, enhanced wound closure, and increased angiogenesis at the injury site. Treatment with Epi-1 decreased serum levels of the proinflammatory cytokines TNF-?, IL-6, and MCP-1, and regulated the recruitment of monocytes and clearance of lymphocytes around the wounded region during healing. In conclusion, Epi-1 may be effective at treating clinical MRSA, and may enhance wound recovery when combined with collagen. PMID:24075409

Huang, Han-Ning; Rajanbabu, Venugopal; Pan, Chieh-Yu; Chan, Yi-Lin; Wu, Chang-Jer; Chen, Jyh-Yih

2013-12-01

325

Analysis of Reporting Time for Identification of Methicillin-Resistant Staphylococcus aureus Carriers Using ChromID MRSA.  

PubMed

We assessed the reporting times for identification of nasal methicillin-resistant Staphylococcus aureus (MRSA) carriers in 2011 in a university-affiliated hospital using surveillance cultures incubated for 1 and 2 days with ChromID MRSA (bioMérieux, France). Of 2,732 nasal swabs tested, MRSA was detected in 829 (85.6%) and 140 (14.4%) swabs after 1 and 2 days of incubation, respectively, and the median reporting times for positive specimens were 33.7 hr (range, 18.2-156.9 hr) and 108.1 hr (range, 69.8-181.0 hr), respectively. Detection rate after 1-day incubation was 85%. Additional 1-day incubation improved detection rate; however, it prolonged the reporting times of positive specimens approximately up to 4 days because of the need for confirmatory tests such as species identification and susceptibility tests. Following a 2-day culture with ChromID MRSA, rapid confirmatory tests are warranted to reduce delay in identifying MRSA carriers. PMID:24790913

Lee, Yirang; Kim, Jae-Seok; Kim, Han-Sung; Kim, Hyun Soo; Song, Wonkeun; Lee, Kyu Man

2014-05-01

326

Analysis of Reporting Time for Identification of Methicillin-Resistant Staphylococcus aureus Carriers Using ChromID MRSA  

PubMed Central

We assessed the reporting times for identification of nasal methicillin-resistant Staphylococcus aureus (MRSA) carriers in 2011 in a university-affiliated hospital using surveillance cultures incubated for 1 and 2 days with ChromID MRSA (bioMérieux, France). Of 2,732 nasal swabs tested, MRSA was detected in 829 (85.6%) and 140 (14.4%) swabs after 1 and 2 days of incubation, respectively, and the median reporting times for positive specimens were 33.7 hr (range, 18.2-156.9 hr) and 108.1 hr (range, 69.8-181.0 hr), respectively. Detection rate after 1-day incubation was 85%. Additional 1-day incubation improved detection rate; however, it prolonged the reporting times of positive specimens approximately up to 4 days because of the need for confirmatory tests such as species identification and susceptibility tests. Following a 2-day culture with ChromID MRSA, rapid confirmatory tests are warranted to reduce delay in identifying MRSA carriers.

Lee, Yirang; Kim, Han-Sung; Kim, Hyun Soo; Song, Wonkeun; Lee, Kyu Man

2014-01-01

327

Increasing the presence of biofilm and healing delay in a porcine model of MRSA-infected wounds.  

PubMed

Data supporting the concept that microbial biofilms are a major cause of non-healing ulcers remain limited. A porcine model was established where delayed healing resulted from methicillin-resistant Staphylococcus aureus (MRSA) infection in full-thickness wounds. At the end of one study a wound remaining open was sampled and a MRSA strain was isolated. This pig-passaged strain was used as the inoculating strain in several subsequent studies. The resulting MRSA wound infections exhibited a greater, more stable tissue bioburden than seen in studies using the parent strain. Furthermore, wounds infected with the passaged strain experienced a greater delay in healing. To understand whether these changes corresponded to an increased biofilm character of the wound infection, wound biopsy samples from studies using either the parent or passaged MRSA strains were examined microscopically. Evidence of biofilm was observed for both strains, as most samples at a minimum had multiple isolated, dense microcolonies of bacteria. However, the passaged MRSA resulted in bacterial colonies of greater frequency and size that occurred more often in concatenated fashion to generate extended sections of biofilm. These results provide a model case in which increasing biofilm character of a wound infection corresponded with a greater delay in wound healing. PMID:22672311

Roche, Eric D; Renick, Paul J; Tetens, Shannon P; Ramsay, Sarah J; Daniels, Egeenee Q; Carson, Dennis L

2012-01-01

328

Modeling the Spread of Methicillin-Resistant Staphylococcus aureus (MRSA) Outbreaks throughout the Hospitals in Orange County, California  

PubMed Central

Background Since hospitals in a region often share patients, an outbreak of methicillin-resistant Staphylococcus aureus (MRSA) infection in one hospital could affect other hospitals. Methods Using extensive data collected from Orange County (OC), California, we developed a detailed agent-based model to represent patient movement among all OC hospitals. Experiments simulated MRSA outbreaks in various wards, institutions, and regions. Sensitivity analysis varied lengths of stay, intraward transmission coefficients (?), MRSA loss rate, probability of patient transfer or readmission, and time to readmission. Results Each simulated outbreak eventually affected all of the hospitals in the network, with effects depending on the outbreak size and location. Increasing MRSA prevalence at a single hospital (from 5% to 15%) resulted in a 2.9% average increase in relative prevalence at all other hospitals (ranging from no effect to 46.4%). Single-hospital intensive care unit outbreaks (modeled increase from 5% to 15%) caused a 1.4% average relative increase in all other OC hospitals (ranging from no effect to 12.7%). Conclusion MRSA outbreaks may rarely be confined to a single hospital but instead may affect all of the hospitals in a region. This suggests that prevention and control strategies and policies should account for the interconnectedness of health care facilities.

Lee, Bruce Y.; McGlone, Sarah M.; Wong, Kim F.; Yilmaz, S. Levent; Avery, Taliser R.; Song, Yeohan; Christie, Richard; Eubank, Stephen; Brown, Shawn T.; Epstein, Joshua M.; Parker, Jon I.; Burke, Donald S.; Platt, Richard; Huang, Susan S.

2012-01-01

329

Livestock-Associated MRSA Carriage in Patients without Direct Contact with Livestock  

PubMed Central

Background Livestock-associated MRSA (MC398) has emerged and is related to an extensive reservoir in pigs and veal calves. Individuals with direct contact with these animals and their family members are known to have high MC398 carriage rates. Until now it was assumed that MC398 does not spread to individuals in the community without pig or veal calf exposure. To test this, we identified the proportion of MC398 in MRSA positive individuals without contact with pigs/veal calves or other known risk factors (MRSA of unknown origin; MUO). Methods In 17 participating hospitals, we determined during two years the occurrence of MC398 in individuals without direct contact with livestock and no other known risk factor (n?=?271) and tested in a post analysis the hypothesis whether hospitals in pig-dense areas have higher proportions of MC398 of all MUO. Results Fifty-six individuals (20.7%) without animal contact carried MC398. In hospitals with high pig-densities in the adherence area, the proportion of MC398 of all MUO was higher than this proportion in hospitals without pigs in the surroundings. Conclusions One fifth of the individuals carrying MUO carried MC398. So, MC398 is found in individuals without contact to pigs or veal calves. The way of transmission from the animal reservoir to these individuals is unclear, probably by human-to-human transmission or by exposure to the surroundings of the stables. Further research is needed to investigate the way of transmission.

van Rijen, Miranda M. L.; Bosch, Thijs; Verkade, Erwin J. M.; Schouls, Leo; Kluytmans, Jan A. J. W.

2014-01-01

330

Treatment of bacteraemia: meticillin-resistant Staphylococcus aureus (MRSA) to vancomycin-resistant S. aureus (VRSA).  

PubMed

Around the world, Staphylococcus aureus remains a dominant cause of bacteraemia. Whilst meticillin resistance remains the major phenotype of concern, various levels of reduced glycopeptide susceptibility are emerging with increasing frequency. The most common MRSA phenotypes now have raised vancomycin MICs within the susceptible range (MICs of 1-2mg/L). This phenomenon, known as MIC creep, is hotly contested and often denied. Key to detecting MIC creep may be to examine isolates fresh, as freezing can allow reversion to wild-type MIC, presumably by loss of mutations. Treatment failure is common with vancomycin and it is uncertain whether higher doses are beneficial. At the other extreme, when enough mutations have accumulated, full VISA status is achieved, although this can also be unstable on storage. Heteroresistant and VISA strains can be considered the inevitable end result of continued MIC creep and are even more likely to fail glycopeptide treatment. Currently full vancomycin resistance is uncommon, with only approximately 20 strains described and confirmed worldwide. Empirical treatment for patients with undefined Gram-positive sepsis can undoubtedly be improved by knowledge of MRSA status, so this is a potential advantage of hospital admission screening. If a patient is risk-assessed or screen-positive for MRSA, and infection is not serious, then vancomycin or teicoplanin is appropriate empirical therapy, providing loading doses are given to achieve therapeutic concentrations immediately (trough 15 mg/L). For life-threatening infections, the glycopeptides are inadequate unless the isolate is likely to be fully susceptible (Etest<1.5mg/L). If not, daptomycin (8-10mg/L) can be used as monotherapy but the MIC should be measured as soon as possible. PMID:23664580

Gould, I M

2013-06-01

331

Future challenges and treatment of Staphylococcus aureus bacteremia with emphasis on MRSA  

PubMed Central

Summary Staphylococcus aureus bacteremia (SAB) is an urgent medical problem due to its growing frequency and its poor associated outcome. As healthcare delivery increasingly involves invasive procedures and implantable devices, the number of patients at risk for SAB and its complications is likely to grow. Compounding this problem is the growing prevalence of methicillin resistant S. aureus (MRSA) and the dwindling efficacy of vancomycin, long the treatment of choice for this pathogen. Despite the recent availability of several new antibiotics for S. aureus, new strategies for treatment and prevention are required for this serious, common cause of human infection.

Rasmussen, Rasmus V.; Fowler, Vance G.; Skov, Robert; Bruun, Niels E.

2011-01-01

332

Computer aided screening and evaluation of herbal therapeutics against MRSA infections.  

PubMed

Methicillin resistant Staphylococcus aureus (MRSA), a pathogenic bacterium that causes life threatening outbreaks such as community-onset and nosocomial infections has emerged as 'superbug'. The organism developed resistance to all classes of antibiotics including the best known Vancomycin (VRSA). Hence, there is a need to develop new therapeutic agents. This study mainly evaluates the potential use of botanicals against MRSA infections. Computer aided design is an initial platform to screen novel inhibitors and the data finds applications in drug development. The drug-likeness and efficiency of various herbal compounds were screened by ADMET and docking studies. The virulent factor of most of the MRSA associated infections are Penicillin Binding Protein 2A (PBP2A) and Panton-Valentine Leukocidin (PVL). Hence, native structures of these proteins (PDB: 1VQQ and 1T5R) were used as the drug targets. The docking studies revealed that the active component of Aloe vera, ?-sitosterol (3S, 8S, 9S, 10R, 13R, 14S, 17R) -17- [(2R, 5R)-5-ethyl-6-methylheptan-2-yl] -10, 13-dimethyl 2, 3, 4, 7, 8, 9, 11, 12, 14, 15, 16, 17- dodecahydro-1H-cyclopenta [a] phenanthren-3-ol) showed best binding energies of -7.40 kcal/mol and -6.34 kcal/mol for PBP2A and PVL toxin, respectively. Similarly, Meliantriol (1S-1-[ (2R, 3R, 5R)-5-hydroxy-3-[(3S, 5R, 9R, 10R, 13S, 14S, 17S)-3-hydroxy 4, 4, 10, 13, 14-pentamethyl-2, 3, 5, 6, 9, 11, 12, 15, 16, 17-decahydro-1H-cyclopenta[a] phenanthren-17-yl] oxolan-2-yl] -2- methylpropane-1, 2 diol), active compound in Azadirachta indica (Neem) showed the binding energies of -6.02 kcal/mol for PBP2A and -8.94 for PVL toxin. Similar studies were conducted with selected herbal compound based on pharmacokinetic properties. All in silico data tested in vitro concluded that herbal extracts of Aloe-vera, Neem, Guava (Psidium guajava), Pomegranate (Punica granatum) and tea (Camellia sinensis) can be used as therapeutics against MRSA infections. PMID:22125390

Skariyachan, Sinosh; Krishnan, Rao Shruti; Siddapa, Snehapriya Bangalore; Salian, Chithra; Bora, Prerana; Sebastian, Denoj

2011-01-01

333

Screening for methicillin resistance in Staphylococcus aureus and coagulase-negative staphylococci: an evaluation of three selective media and Mastalex-MRSA latex agglutination.  

PubMed

Laboratory confirmation of MRSA is important for the implementation of infection control; conventional screening culture methods take up to five days for confirmation. The purpose of this study is to ascertain the efficiency of three selective media for growth of methicillin-resistant Staphylococcus aureus (MRSA) before and after enrichment in salt broth, and to evaluate the Mastalex-MRSA latex agglutination kit for detection of methicillin resistance. Screening swabs were collected from 63 patients, yielding 125 S. aureus isolates and 40 coagulase-negative staphylococcus (CNS) isolates. Selective media used were mannitol salt agar (MSA), Baird-Parker agar with ciprofloxacin (BPC) and bromocresol purple (BCPA). Polymerase chain reaction (PCR) for mecA gene detection was used as the reference standard for evaluation of the Mastalex-MRSA assay, which was also evaluated on colonies of S. aureus from the selective media. No significant difference was found in efficiency of MRSA isolation among the selective media. Pre-enrichment in the salt broth did not enhance isolation of MRSA. Methicillin-sensitive S. aureus and CNS were significantly inhibited in all selective media (P<0.05). Only BPC significantly selected out methicillin-resistant CNS (P<0.01). Mastalex-MRSA was 97% specific and sensitive for the detection of MRSA. It was 65% sensitive and 100% specific in detecting methicillin resistance in CNS. In conclusion, all selective media performed equally well (MRSA isolation rate of approximately 80%). Mastalex-MRSA provided rapid and reliable detection of MRSA from selective media, reducing the time required for confirmation of this organism. PMID:12866912

Bowers, K M; Wren, M W D; Shetty, N P

2003-01-01

334

A randomized, controlled trial of tea tree topical preparations versus a standard topical regimen for the clearance of MRSA colonization.  

PubMed

Two topical MRSA eradication regimes were compared in hospital patients: a standard treatment included mupirocin 2% nasal ointment, chlorhexidine gluconate 4% soap, silver sulfadiazine 1% cream versus a tea tree oil regimen, which included tea tree 10% cream, tea tree 5% body wash, both given for five days. One hundred and fourteen patients received standard treatment and 56 (49%) were cleared of MRSA carriage. One hundred and ten received tea tree oil regimen and 46 (41%) were cleared. There was no significant difference between treatment regimens (Fisher's exact test; P = 0.0286). Mupirocin was significantly more effective at clearing nasal carriage (78%) than tea tree cream (47%; P = 0.0001) but tea tree treatment was more effective than chlorhexidine or silver sulfadiazine at clearing superficial skin sites and skin lesions. The tea tree preparations were effective, safe and well tolerated and could be considered in regimens for eradication of MRSA carriage. PMID:15066738

Dryden, M S; Dailly, S; Crouch, M

2004-04-01

335

A lean Six Sigma team increases hand hygiene compliance and reduces hospital-acquired MRSA infections by 51%.  

PubMed

A low hand hygiene compliance rate by healthcare workers increases hospital-acquired infections to patients. At Presbyterian Healthcare Services in Albuquerque, New Mexico a Lean Six Sigma team identified the reasons for noncompliance were multifaceted. The team followed the DMAIC process and completed the methodology in 12 months. They implemented multiple solutions in the three areas: Education, Culture, and Environment. Based on methicillin-resistant Staphylococcus aureus (MRSA) mortality research the team's results included an estimated 2.5 lives saved by reducing MRSA infections by 51%. Subsequently this 51% decrease in MRSA saved the hospital US$276,500. For those readers tasked with increasing hand hygiene compliance this article will provide the knowledge and insight needed to overcome multifaceted barriers to noncompliance. PMID:20618572

Carboneau, Clark; Benge, Eddie; Jaco, Mary T; Robinson, Mary

2010-01-01

336

[Are mothers of children with neurodermatitis psychologically conspicuous? Critique and replication of a study of the "psychosomatic aspects of the parent-child relationship in pediatric atopic eczema"].  

PubMed

A study concerning some "psychosomatic aspects of the parent-child relationship and atopic eczema in childhood" was published in this journal in 1986 [8]. The authors concluded that mothers of children suffering from atopic eczema "were shown to be less 'spontaneous', more 'under control' and less 'emotional' than the normal population." They showed "characteristic features indicating difficulties in emotional relationships with their children." These conclusions were based on the answers of 14 mothers to a popular German personality questionnaire (Freiburger Persönlichkeitsinventar, FPI). We analyzed the investigation cited, judged it to be unsatisfactory and attempted to duplicate the study. Two parallel samples of mothers with healthy and ill children (n = 50 and n = 47) were tested with the same questionnaire. The previous results could not be verified. Therefore, we reject the interpretation that mothers of children suffering from atopic eczema have unique psychological characteristics. PMID:7591765

Langfeldt, H P

1995-09-01

337

Isolation of a potent antibiotic producer bacterium, especially against MRSA, from northern region of the Persian Gulf.  

PubMed

Nowadays, emergence and prevalence of MRSA (Methicillin Resistant Staphylococcus aureus) strain have become a great global concern in 21st century, so, it is necessary to discover new antibiotics against this pathogen. The aim of this study was isolation and evaluation marine bacteria from the Persian Gulf in order to finding antibiotic compounds against some pathogenic bacteria. For this purpose, water and sediment samples were collected from the Persian Gulf during March to October 2009. The antibacterial activity of the isolated bacteria was assessed using disc diffusion method. The Growth Curve Interference (GCI) parameter against MRSA was determined for the high potential antibiotic producing strain. The most important factors affecting fermentation conditions in antibiotic production were also optimized. Definite identification of intended isolate was confirmed by 16S rRNA sequencing. Altogether, 51 bacterial colony was isolated and among them only 3 bacterium showed antibacterial activity. Pseudoalteromonas piscicida PG-01 isolated from a sediment sample was chosen as the best antibiotic producing strain. This strain was effective against all tested Gram-positive bacteria, had good anti-MRSA activity and also GCI value against MRSA was two times lower than MIC value. Among the optimized fermentation parameters, carbon and nitrogen sources play major role in efficacy of optimized antibiotic production. Ultrastructural study on the effect of intended antibiotic compounds on MRSA using TEM revealed that the target site for this compound is cell wall. Considering the antibacterial effect of PG-01 strain especially against MRSA, intended antibiotic compounds can gives hope for treatment of diseases caused by multi-drug resistant bacteria. PMID:22642595

Darabpour, Esmaeil; Roayaei Ardakani, Mohammad; Motamedi, Hossein; Taghi Ronagh, Mohammad

2012-05-01

338

Linezolid minimum inhibitory concentration (MIC) creep in methicillin-resistant Staphylococcus aureus (MRSA) clinical isolates at a single Japanese center.  

PubMed

The aim of this study was to evaluate whether linezolid minimum inhibitory concentration (MIC) creep occurred in Staphylococcus aureus clinical isolates, including methicillin-resistant S. aureus (MRSA), over a recent 5-year period at a single Japanese center. A total of 453 MRSA and 195 methicillin-susceptible S. aureus (MSSA) isolates recovered from inpatients from April 1, 2008 to March 31, 2013 were analyzed. The MIC of linezolid was determined by automated Vitek-2 system. The modal MIC, MIC range, MIC50 and MIC90 (MICs required to inhibit the growth of 50% and 90% of organisms, respectively), geometric mean MIC and percentages of susceptible and resistant isolates were evaluated for each fiscal year. None of the S. aureus isolates were resistant to linezolid. Isolates with an MIC of >1 µg/mL were more common in the MSSA samples than in the MRSA samples (91.3% versus 38.2%, p<0.001). The linezolid geometric mean MIC increased by 0.403 µg/mL (from 1.178 in 2008 to 1.582 in 2012) in the MRSA isolates (p=0.006, r(2)=0.945 according to a linear regression analysis) over the 5-year period; however, no increase was observed in the MSSA isolates. The frequency of MRSA isolates with an MIC of 1 µg/mL decreased (from 76.3% in 2008 to 35.4% in 2012) and the isolates with MICs of >1 µg/mL increased over time (from 23.7% in 2008 to 64.6% in 2012). This report demonstrates the occurrence of linezolid MIC creep, as determined using the geometric mean MIC, in MRSA clinical isolates at a single Japanese center. PMID:24694615

Miyazaki, Motoyasu; Nagata, Nobuhiko; Miyazaki, Hiroyuki; Matsuo, Koichi; Takata, Tohru; Tanihara, Shinichi; Kamimura, Hidetoshi

2014-01-01

339

The Mechanism of Heterogeneous Beta-Lactam Resistance in MRSA: Key Role of the Stringent Stress Response  

PubMed Central

All methicillin resistant S. aureus (MRSA) strains carry an acquired genetic determinant – mecA or mecC - which encode for a low affinity penicillin binding protein –PBP2A or PBP2A? – that can continue the catalysis of peptidoglycan transpeptidation in the presence of high concentrations of beta-lactam antibiotics which would inhibit the native PBPs normally involved with the synthesis of staphylococcal cell wall peptidoglycan. In contrast to this common genetic and biochemical mechanism carried by all MRSA strains, the level of beta-lactam antibiotic resistance shows a very wide strain to strain variation, the mechanism of which has remained poorly understood. The overwhelming majority of MRSA strains produce a unique – heterogeneous – phenotype in which the great majority of the bacteria exhibit very poor resistance often close to the MIC value of susceptible S. aureus strains. However, cultures of such heterogeneously resistant MRSA strains also contain subpopulations of bacteria with extremely high beta-lactam MIC values and the resistance level and frequency of the highly resistant cells in such strain is a characteristic of the particular MRSA clone. In the study described in this communication, we used a variety of experimental models to understand the mechanism of heterogeneous beta-lactam resistance. Methicillin-susceptible S. aureus (MSSA) that received the mecA determinant in the laboratory either on a plasmid or in the form of a chromosomal SCCmec cassette, generated heterogeneously resistant cultures and the highly resistant subpopulations that emerged in these models had increased levels of PBP2A and were composed of bacteria in which the stringent stress response was induced. Each of the major heterogeneously resistant clones of MRSA clinical isolates could be converted to express high level and homogeneous resistance if the growth medium contained an inducer of the stringent stress response.

Kim, Choonkeun; Mwangi, Michael; Chung, Marilyn; Milheirco, Catarina; de Lencastre, Herminia; Tomasz, Alexander

2013-01-01

340

Experimental Endocarditis Model of Methicillin Resistant Staphylococcus aureus (MRSA) in Rat  

PubMed Central

Endovascular infections, including endocarditis, are life-threatening infectious syndromes1-3. Staphylococcus aureus is the most common world-wide cause of such syndromes with unacceptably high morbidity and mortality even with appropriate antimicrobial agent treatments4-6. The increase in infections due to methicillin-resistant S. aureus (MRSA), the high rates of vancomycin clinical treatment failures and growing problems of linezolid and daptomycin resistance have all further complicated the management of patients with such infections, and led to high healthcare costs7, 8. In addition, it should be emphasized that most recent studies with antibiotic treatment outcomes have been based in clinical settings, and thus might well be influenced by host factors varying from patient-to-patient. Therefore, a relevant animal model of endovascular infection in which host factors are similar from animal-to-animal is more crucial to investigate microbial pathogenesis, as well as the efficacy of novel antimicrobial agents. Endocarditis in rat is a well-established experimental animal model that closely approximates human native valve endocarditis. This model has been used to examine the role of particular staphylococcal virulence factors and the efficacy of antibiotic treatment regimens for staphylococcal endocarditis. In this report, we describe the experimental endocarditis model due to MRSA that could be used to investigate bacterial pathogenesis and response to antibiotic treatment.

Hady, Wessam Abdel; Bayer, Arnold S.; Xiong, Yan Q.

2012-01-01

341

A Natural Plasmid Uniquely Encodes Two Biosynthetic Pathways Creating a Potent Anti-MRSA Antibiotic  

PubMed Central

Background Understanding how complex antibiotics are synthesised by their producer bacteria is essential for creation of new families of bioactive compounds. Thiomarinols, produced by marine bacteria belonging to the genus Pseudoalteromonas, are hybrids of two independently active species: the pseudomonic acid mixture, mupirocin, which is used clinically against MRSA, and the pyrrothine core of holomycin. Methodology/Principal Findings High throughput DNA sequencing of the complete genome of the producer bacterium revealed a novel 97 kb plasmid, pTML1, consisting almost entirely of two distinct gene clusters. Targeted gene knockouts confirmed the role of these clusters in biosynthesis of the two separate components, pseudomonic acid and the pyrrothine, and identified a putative amide synthetase that joins them together. Feeding mupirocin to a mutant unable to make the endogenous pseudomonic acid created a novel hybrid with the pyrrothine via “mutasynthesis” that allows inhibition of mupirocin-resistant isoleucyl-tRNA synthetase, the mupirocin target. A mutant defective in pyrrothine biosynthesis was also able to incorporate alternative amine substrates. Conclusions/Significance Plasmid pTML1 provides a paradigm for combining independent antibiotic biosynthetic pathways or using mutasynthesis to develop a new family of hybrid derivatives that may extend the effective use of mupirocin against MRSA.

Song, Zhongshu; Murphy, Annabel C.; Hothersall, Joanne; Stephens, Elton R.; Gurney, Rachel; Cox, Russell J.; Crosby, John; Willis, Christine L.; Simpson, Thomas J.; Thomas, Christopher M.

2011-01-01

342

Novel quercetin glycosides as potent anti-MRSA and anti-VRE agents.  

PubMed

Each year in the United States, at least 2 million people become infected with bacteria that are resistant to antibiotics and at least 23,000 people die each year as a direct result of these infections (Threat report 2013). Vancomycin is an FDA approved antibiotic and is growing importance in the treatment of hospital infections, with particular emphasis on its value to fight against methicillin-resistant Staphylococcus aureus (MRSA). The increasing use of vancomycin to treat infections caused by the Gram-positive MRSA in the 1970s selected for drug-resistant enterococci, less potent than staphylococci but opportunistic in the space vacated by other bacteria and in patients with compromised immune systems. The dramatic rise of antibiotic-resistant bacteria over the past two decades has stressed the need for completely novel classes of antibacterial agents. This paper reports the recent patent review on the strategy for finding novel quercetinglycoside type antibacterial agents against vancomycin-resistant bacterial strains. PMID:24320230

Hossion, Abugafar M L; Sasaki, Kenji

2013-12-01

343

Nasal carriage of MRSA: the role of mupirocin and outlook for resistance.  

PubMed

Since the first attempts (1) to eradicate nasal carriage of Staphylococcus aureus with local applications of penicillin, many other topical and systemic antimicrobial agents have been tested, all with limited success. More recently, mupirocin has been much more successful and, in a controlled trial, nasal carriage of S. aureus was eliminated in all subjects and when re-colonisation eventually took place, only 29% had relapsed with their pre-treatment strain. During an MRSA outbreak at a London hospital, standard infection control measures failed to prevent colonisation and infection of more than two hundred patients, but the use of mupirocin was associated with epidemiological control. Of forty patients and thirty-two staff studied, 98.6% of staff and 90.1% of patient-weeks were free of nasal MRSA after treatment. Although resistance to at least 40 mg/l of mupirocin can be produced in vitro and resistant S. aureus have been isolated from patients undergoing prolonged skin treatment with mupirocin, there has been no evidence for the emergence of mupirocin resistance as a mechanism for the relapse of nasal carriage. PMID:2129029

Hill, R L; Casewell, M W

1990-01-01

344

Clinical severity correlates with impaired barrier in filaggrin-related eczema.  

PubMed

Mutations in the gene-encoding filaggrin (FLG), a key molecule involved in skin barrier function, have been shown to be a major predisposing factor for atopic dermatitis (AD; eczema). To elucidate the pathomechanisms underlying filaggrin-related AD, we investigated stratum corneum (SC) hydration and transepidermal water loss (TEWL) as parameters of barrier function in AD patients harboring FLG mutations compared to AD patients without any FLG mutation. In filaggrin-related AD, SC hydration was both significantly reduced (P<0.01-0.05) and thicker (P<0.01-0.05) than that in healthy controls. TEWL was demonstrably increased in non-filaggrin AD compared to healthy controls (P<0.01-0.05). The objective score of atopic dermatitis (OSCORAD), a disease clinical severity index, significantly correlated with TEWL (r=0.81, P<0.005), SC hydration (r=-0.65, P<0.05), and SC thickness (r=0.59, P<0.05) in filaggrin-related AD. On the contrary, there was no correlation between these parameters and the OSCORAD in non-filaggrin AD. Furthermore, a significant correlation was obtained between the OSCORAD and specific IgE for house dust (r=0.66, P<0.05), mite allergen (r=0.53, P<0.05), and cat dander (r=0.64, P<0.05) in filaggrin-related AD, but not in non-filaggrin AD. All these data suggest that experimentally demonstrable skin barrier defects due to FLG mutations may play a crucial role in the pathogenesis of AD. PMID:18818676

Nemoto-Hasebe, Ikue; Akiyama, Masashi; Nomura, Toshifumi; Sandilands, Aileen; McLean, W H Irwin; Shimizu, Hiroshi

2009-03-01

345

Surveillance of Physician-Diagnosed Skin and Soft Tissue Infections Consistent With Methicillin-Resistant "Staphylococcus aureus" (MRSA) among Nebraska High School Athletes, 2008-2012  

ERIC Educational Resources Information Center

Though historically confined to hospital settings, methicillin-resistant Staphylococcus aureus (MRSA) has received increasing attention in the wider community, particularly among athletes. A 2007-2008 investigation in Nebraska concluded that MRSA skin infections were an emerging problem among the state's student athletes. Statewide…

Buss, Bryan F.; Connolly, Susan

2014-01-01

346

A STUDY OF THE EFFECTS OF DIFFERENT DISINFECTANTS USED IN RIYADH HOSPITALS AND THEIR EFFICACY AGAINST METHICILLIN RESISTANT STAPHYLOCOCCUS AUREUS (MRSA)  

Microsoft Academic Search

Methicillin resistant Staphylococcus aureus (MRSA) and the means of controlling it, continue to be of major interest to the healthcare community. The bactericidal activity of some disinfectants which are in common use in seven major tertiary care hospitals in Riyadh was tested against two control strains of S. aureus, namely MRSA ATCC 33591 and Methicillin sensitive Staphylococcus aureus (MSSA) ATCC

Manal M. Baddour

347

Interactive effect of STAT6 and IL13 gene polymorphisms on eczema status: results from a longitudinal and a cross-sectional study  

PubMed Central

Background Eczema is a prevalent skin disease that is mainly characterized by systemic deviation of immune response and defective epidermal barrier. Th2 cytokines, such as IL-13 and transcription factor STAT6 are key elements in the inflammatory response that characterize allergic disorders, including eczema. Previous genetic association studies showed inconsistent results for the association of single nucleotide polymorphisms (SNPs) with eczema. Our aim was to investigate whether SNPs in IL13 and STAT6 genes, which share a biological pathway, have an interactive effect on eczema risk. Methods Data from two independent population-based studies were analyzed, namely the Isle of Wight birth cohort study (IOW; n?=?1,456) and for the purpose of replication the Swansea PAPA (Poblogaeth Asthma Prifysgol Abertawe; n?=?1,445) cross-sectional study. Log-binomial regressions were applied to (i) account for the interaction between IL13 (rs20541) and STAT6 (rs1059513) polymorphisms and (ii) estimate the combined effect, in terms of risk ratios (RRs), of both risk factors on the risk of eczema. Results Under a dominant genetic model, the interaction term [IL13 (rs20541)?×?STAT6 (rs1059513)] was statistically significant in both studies (IOW: adjusted Pinteraction?=?0.046; PAPA: Pinteraction?=?0.037). The assessment of the combined effect associated with having risk genotypes in both SNPs yielded a 1.52-fold increased risk of eczema in the IOW study (95% confidence interval (CI): 1.05 – 2.20; P?=?0.028) and a 2.01-fold higher risk of eczema (95% CI: 1.29 – 3.12; P?=?0.002) in the PAPA study population. Conclusions Our study adds to the current knowledge of genetic susceptibility by demonstrating for the first time an interactive effect between SNPs in IL13 (rs20541) and STAT6 (rs1059513) on the occurrence of eczema in two independent samples. Findings of this report further support the emerging evidence that points toward the existence of genetic effects that occur via complex networks involving gene-gene interactions (epistasis).

2013-01-01

348

Immunomorphological and Ultrastructural Characterization of Langerhans Cells and a Novel, Inflammatory Dendritic Epidermal Cell (IDEC) Population in Lesional Skin of Atopic Eczema  

Microsoft Academic Search

We investigated epidermal cell suspensions prepared from lesional and nonlesional atopic eczema skin, other inflammatory skin conditions, and normal human skin for high-affinity IgE receptor (Fc?RI) expression on dendritic CD1a cells by quantitative flow cytometric analysis. A single CD1abright\\/CD1bneg\\/Fc?RIdim\\/CD23neg\\/CD32dim\\/HLA-DRbright\\/CD36negpopulation was found in normal skin. In contrast, lesional skin of atopic eczema and other inflammatory skin diseases harbored variable proportions of

Andreas Wollenberg; Stefan Kraft; Daniel Hanau; Thomas Bieber

1996-01-01

349

PS2-36: Population-based Evaluation of Patients with Methicillin-resistant Staphylococcus aureus (MRSA) Infection in Relation to Animal Feeding Operations in Pennsylvania  

PubMed Central

Background/Aims New MRSA strains and epidemiologic patterns of infection have emerged in the past decade, with community-associated patterns now dominant. In Europe, these new community strains have been linked to animal feeding operations (AFOs), raising concerns about the widespread use of non-therapeutic antibiotics in animal feeds. No prior population-based studies have evaluated the risk of MRSA infection in relation to AFOs in the U.S. Methods We used Geisinger Clinic electronic health record data from 2001 to February 2010 on all primary care patients (n = 440,000). Three groups of patients were identified using specific ICD-9 codes: Community-onset MRSA (CO-MRSA) without risk factors (i.e., infection diagnosed as an outpatient, no antibiotics or hospitalizations in the prior year, no household contacts, no history of MRSA colonization); Hospital-onset MRSA (HO-MRSA) with risk factors (i.e., diagnosed in the hospital with at least one MRSA risk factor); and Skin infection (e.g., cellulitis, carbuncle, skin abscess) without MRSA infection or colonization history and without MRSA risk factors. MRSA cases were frequency-matched to controls with no history of MRSA or risk factors. Information on concentrated animal feeding operations (CAFOs) were obtained from the Pennsylvania Department of Environmental Protection, and included data on animal species (e.g., swine, dairy cattle, chickens), counts, animal equivalent units (AEUs), farm acreage, and manure generated, exported, and stored. Measures of density (e.g., AEUs per sq. mi. in township) and accessibility (e.g., distance from residence to nearest CAFO, gravity models) were derived and used in logistic regression models comparing the four groups. Results A total of 1926 MRSA cases were identified from 2003 to 2010. Of these, 1058 (55%) were identified in outpatient records, 530 (28%) from inpatient records, and 290 (15%) from medication orders. Inpatient cases increased from 2 in 2003 to 88 in 2005, remained at the same frequency through 2008, and then increased to 116 in 2009. In contrast, outpatient cases increased steadily from 4 in 2003 to a peak of 325 in 2008. Conclusions The data clearly show a steady increase in the incidence of CO-MRSA in this region. Relations with AFOs will be presented and discussed.

Schwartz, Brian; Pollak, Jonathan; Mercer, Dione; DeWalle, Joseph; Stewart, Walter

2011-01-01

350

Nasal carriage of methicillin-resistant Staphylococcus aureus (MRSA) among Swiss veterinary health care providers: Detection of livestock- and healthcare-associated clones.  

PubMed

We screened a total of 340 veterinarians (including general practitioners, small animal practitioners, large animal practitioners, veterinarians working in different veterinary services or industry), and 29 veterinary assistants for nasal carriage of methicillin-resistant Staphylococcus aureus (MRSA) and Staphylococcus pseudintermedius (MRSP) at the 2012 Swiss veterinary annual meeting. MRSA isolates (n = 14) were detected in 3.8 % (95 % CI 2.1 - 6.3 %) of the participants whereas MRSP was not detected. Large animal practitioners were carriers of livestock-associated MRSA (LA-MRSA) ST398-t011-V (n = 2), ST398-t011-IV (n = 4), and ST398-t034-V (n = 1). On the other hand, participants working with small animals harbored human healthcare-associated MRSA (HCA-MRSA) which belonged to epidemic lineages ST225-t003-II (n = 2), ST225-t014-II (n = 1), ST5-t002-II (n = 2), ST5-t283-IV (n = 1), and ST88-t186-IV (n = 1). HCA-MRSA harbored virulence factors such as enterotoxins, ?-hemolysin converting phage and leukocidins. None of the MRSA isolates carried Panton-Valentine leukocidin (PVL). In addition to the methicillin resistance gene mecA, LA-MRSA ST398 isolates generally contained additional antibiotic resistance genes conferring resistance to tetracycline [tet(M) and tet(K)], trimethoprim [dfrK, dfrG], and the aminoglycosides gentamicin and kanamycin [aac(6')-Ie - aph(2')-Ia]. On the other hand, HCA-MRSA ST5 and ST225 mainly contained genes conferring resistance to the macrolide, lincosamide and streptogramin B antibiotics [erm(A)], to spectinomycin [ant(9)-Ia], amikacin and tobramycin [ant(4')-Ia], and to fluoroquinolones [amino acid substitutions in GrlA (S84L) and GyrA (S80F and S81P)]. MRSA carriage may represent an occupational risk and veterinarians should be aware of possible MRSA colonization and potential for developing infection or for transmitting these strains. Professional exposure to animals should be reported upon hospitalization and before medical intervention to allow for preventive measures. Infection prevention measures are also indicated in veterinary medicine to avoid MRSA transmission between humans and animals, and to limit the spread of MRSA both in the community, and to animal and human hospitals. PMID:24973319

Wettstein Rosenkranz; Rothenanger; Brodard; Collaud; Overesch; Bigler; Marschall; Perreten

2014-07-01

351

Isolation of a small molecule with anti-MRSA activity from a mangrove symbiont Streptomyces sp. PVRK-1 and its biomedical studies in Zebrafish embryos  

PubMed Central

Objective The aim of the present study was to isolate the anti-MRSA (Methicillin Resistant Staphylococcus aureus) molecule from the Mangrove symbiont Streptomyces and its biomedical studies in Zebrafish embryos. Methods MRSA was isolated from the pus samples of Colachal hospitals and confirmed by amplification of mecA gene. Anti-MRSA molecule producing strain was identified by 16s rRNA gene sequencing. Anti-MRSA compound production was optimized by Solid State Fermentation (SSF) and the purification of the active molecule was carried out by TLC and RP-HPLC. The inhibitory concentration and LC50 were calculated using Statistical software SPSS. The Biomedical studies including the cardiac assay and organ toxicity assessment were carried out in Zebrafish. Results The bioactive anti-MRSA small molecule A2 was purified by TLC with Rf value of 0.37 with 1.389 retention time at RP-HPLC. The Inhibitory Concentration of the purified molecule A2 was 30 µg/mL but, the inhibitory concentration of the MRSA in the infected embryo was 32-34 µg/mL for TLC purified molecule A2 with LC50 mean value was 61.504 µg/mL. Zebrafish toxicity was assessed in 48-60 µg/mL by observing the physiological deformities and the heart beat rates (HBR) of embryos for anti MRSA molecule showed the mean of 41.33-41.67 HBR/15 seconds for 40 µg/mL and control was 42.33-42.67 for 15 seconds which significantly showed that the anti-MRSA molecule A2 did not affected the HBR. Conclusions Anti-MRSA molecule from Streptomyces sp PVRK-1 was isolated and biomedical studies in Zebrafish model assessed that the molecule was non toxic at the minimal inhibitory concentration of MRSA.

Kannan, Rajaretinam Rajesh; Iniyan, Appadurai Muthamil; Prakash, Vincent Samuel Gnana

2011-01-01

352

Quantifying The Impact of Extra-Nasal Testing Body Sites for MRSA Colonization at the Time of Hospital or Intensive Care Unit Admission  

PubMed Central

Objective Methicillin-resistant Staphylococcus aureus (MRSA) is a common cause of healthcare-associated infections. Recent legislative mandates require nares screening for MRSA at hospital and ICU admission in many states. However, MRSA colonization at extra-nasal sites is increasingly recognized. We conducted a systematic review of the literature to identify the yield of extra-nasal testing for MRSA. Design We searched MEDLINE from January 1966 through January 2012 for articles comparing nasal and extra-nasal screening for MRSA colonization. Studies were categorized by population tested, specifically those admitted to ICUs, and those admitted to hospitals with a high prevalence (?6%) or low prevalence (<6%) of MRSA carriers. Data were extracted using a standardized instrument. Results We reviewed 4,381 abstracts and 735 manuscripts. Twenty-three manuscripts met criteria for analysis (n=39,479 patients). Extra-nasal MRSA screening increased yield by approximately one-third over nares alone. The yield was similar upon ICU admission (weighted average 33%, range 9%–69%), and hospital admission in high (weighted average 37%, range 9–86%) and low prevalence (weighted average 50%, range 0–150%) populations. Comparing individual extra nasal sites, testing the oropharynx increased MRSA detection by 21% over nares alone; rectum by 20%; wounds by 17%; and axilla by 7%. Conclusions Extra-nasal MRSA screening at hospital or ICU admission in adults will increase MRSA detection by one-third compared to nares screening alone. Findings were consistent among subpopulations examined. Extra-nasal testing may be a valuable strategy for outbreak control or in settings of persistent disease, particularly when combined with decolonization or enhanced infection prevention protocols.

McKinnell, James A.; Huang, Susan S.; Eells, Samantha J.; Cui, Eric; Miller, Loren G.

2013-01-01

353

Adjustment of the MRSA Search and Destroy policy for outpatients in the Netherlands: a prospective cohort study with repeated prevalence measurements  

PubMed Central

Background In the Netherlands a successful MRSA Search and Destroy policy is applied in healthcare institutes. We determined the effect of an adjustment in the MRSA Search and Destroy policy for patients in the outpatient clinic on the MRSA transmission to health care workers (HCW). Methods In June 2008 an adjustment in the policy for outpatients was introduced in a large teaching hospital. Following this adjustment MRSA positive patients and patients at risk could be seen and treated applying general precautions, without additional protective measures. Also, disinfection of the room after the patient had left was abandoned. To monitor the effect of this policy on the transmission of MRSA all physicians and health care workers of the outpatient clinic were screened for MRSA carriage repeatedly. Results Before the introduction of the adjusted policy all physicians and HCW of the outpatient clinic were screened (=0-measurement, n?=?1,073). None of them was found to be MRSA positive. After introduction of the policy in June 2008 the screening was repeated in October 2008 (n?=?1,170) and April 2009 (n?=?1,128). In April 2009 one health care worker was MRSA positive resulting in a mean prevalence of 0.09%. This is lower than the known prevalence in HCW. The health care worker was colonized with the livestock-related Spa type t011. As far as we could verify, no patients with this Spa-type had been cared for by the health care worker. Conclusions The adjusted MRSA policy did not lead to detectable transmission of MRSA to HCW and was associated with less disturbances in the work flow.

2014-01-01

354

Tacrolimus 0.1% vs mometasone furoate topical treatment in allergic contact hand eczema: a prospective randomized clinical study.  

PubMed

Tacrolimus is a macrolide immunosuppressant that has been demonstrated to inhibit T-lymphocyte activation without the side-effects of corticosteroids. The safety profile of tacrolimus makes it a promising therapeutic option for dermatitis. To evaluate and compare the therapeutic ability of tacrolimus 0.1% ointment and mometasone furoate 0.1% ointment in patients with chronic hand eczema and positive patch tests. Thirty adults with chronic hand eczema and positive patch test reaction to relevant contact allergens were treated with tacrolimus 0.1% ointment or mometasone furoate 0.1% ointment in a single-centre, randomized comparative study. The scores of the evaluated clinical parameters (erythema, infiltration, vesiculation, desquamation, presence of cracks and itching) did not differ between Groups A and B at any of the four time points (p>0.05).On the other hand, in both groups, a significant difference was detected in all parameters between baseline and Day 90 recorded values. Tacrolimus is a promising alternative therapy for contact dermatitis patients as it is effective from the first month of treatment, well tolerated and offers similar therapeutic results to topical corticosteroid therapy. PMID:22407003

Katsarou, Alexandra; Makris, Manolis; Papagiannaki, Konstantina; Lagogianni, Eirini; Tagka, Anna; Kalogeromitros, Dimitrios

2012-01-01

355

A novel treatment option for MRSA pneumonia: ceftaroline fosamil-yielding new hope in the fight against a persistent infection.  

PubMed

Methicillin-resistant Staphylococcus aureus (MRSA) hospital-acquired pneumonia (HAP) and healthcare-associated pneumonia (HCAP) patients treated with current antibiotic therapies have exhibited poor outcomes, increased hospital length of stay, and higher costs of care. The optimal management of these infections is undetermined; thus, it is critical to look at ways to improve outcomes in these patients. There is insufficient data on clinical efficacy in patients with MRSA HAP or HCAP infection treated with ceftaroline-fosamil. In a recent pilot study, nearly 90% of patients treated with ceftaroline-fosamil survived, despite the difficulties associated with administrating bactericidal antimicrobial therapy for this increasingly resistant pathogen. These data suggest a possible benefit in the use of ceftaroline-fosamil for MRSA pneumonia. Presently, we have identified cases over a two-year period treated with ceftaroline-fosamil, and will conduct a comparative analysis to controls (those treated with vancomycin and/or cefepime, and linezolid) to determine optimal therapeutic agents; these findings will have important implications for control of further spread of infection, recurrence, readmission, and mortality attributable to MRSA HAP and HCAP. PMID:24898885

Arshad, Samia; Hartman, Pamela; Zervos, Marcus J

2014-07-01

356

Complete Genome Sequence of Staphylococcus aureus T0131, an ST239-MRSA-SCCmec Type III Clone Isolated in China?  

PubMed Central

We report here the complete genome sequence of Staphylococcus aureus T0131, which is a multiresistant clinical isolate recovered in China and the first sequenced epidemic ST239-MRSA-SCCmec type III strain obtained in Asia. Comparison with two published genomes of ST239 reveals the polymorphism among strains of this type from different continents.

Li, Yang; Cao, Boyang; Zhang, Yongfu; Zhou, Jiali; Yang, Bin; Wang, Lei

2011-01-01

357

Risk factors for methicillin-resistant Staphylococcus aureus (MRSA) infection in dogs and cats: a case-control study  

PubMed Central

Risk factors for methicillin-resistant Staphylococcus aureus (MRSA) infection in dogs and cats were investigated in an unmatched case-control study. A total of 197 animals from 150 veterinary practices across the United Kingdom was enrolled, including 105 MRSA cases and 92 controls with methicillin-susceptible S. aureus (MSSA) infection. The association of owners and veterinarian staff with the human healthcare sector (HCS) and animal-related characteristics such as signalment, antimicrobial and immunosuppressive therapy, and surgery were evaluated as putative risk factors using logistic regression. We found that significant risk factors for MRSA infection were the number of antimicrobial courses (p = 0.005), number of days admitted to veterinary clinics (p = 0.003) and having received surgical implants (p = 0.001). In addition, the odds of contact with humans which had been ill and admitted to hospital (p = 0.062) were higher in MRSA infected pets than in MSSA controls. The risk factors identified in this study highlight the need to increase vigilance towards identification of companion animal groups at risk and to advocate responsible and judicious use of antimicrobials in small animal practice.

Soares Magalhaes, Ricardo Jorge; Loeffler, Anette; Lindsay, Jodi; Rich, Mick; Roberts, Larry; Smith, Heather; Lloyd, David Hugh; Pfeiffer, Dirk Udo

2010-01-01

358

Anti-Glucosaminidase Monoclonal Antibodies as a Passive Immunization for Methicillin-Resistant Staphylococcus aureus (MRSA) Orthopaedic Infections.  

PubMed

Recently, methicillin-resistant Staphylococcus aureus (MRSA) has surpassed HIV as the most deadly pathogen in the United States, accounting for over 100,000 deaths per year. In orthopedics, MRSA osteomyelitis has become the greatest concern in patient care, despite the fact that improvements in surgical technique and aggressive antibiotic prophylaxis have decreased the infection rate for most procedures to less than 5%. This great concern is largely due to the very poor outcomes associated with MRSA osteomyelitis, which includes 30-50% failure rates for revision surgery. Thus, there is a need to develop additional therapeutic interventions such as passive immunization, particularly for immunocompromised patients and the elderly who are typically poor responders to active vaccines. Using a novel murine model of implant-associated osteomyelitis in which a stainless steel pin is coated with bioluminescent S. aureus and implanted transcortically through the tibial metaphysis, we discovered that mice protect themselves from this infection by mounting a specific IgG2b response against the peptidoglycan hydrolase, glucosaminidase (Gmd), an enzyme involved in cell wall digestion during binary fission. Since this subunit of S. aureus autolysin is essential for bacterial growth, and no genetic variation has been identified among clinical strains, we propose that monoclonal antibodies against this enzyme would have multiple mechanisms of action, including promotion of opsonophagocytosis and direct inhibition of enzyme function. Here we review the field of MRSA osteomyelitis and our research to date on the development of an anti-Gmd passive immunotherapy. PMID:22328866

Varrone, John J; Li, Dan; Daiss, John L; Schwarz, Edward M

2011-04-01

359

X-ray CT and pneumonia inhibition properties of gold-silver nanoparticles for targeting MRSA induced pneumonia.  

PubMed

Non-invasive assay for the early stage diagnosis of methicillin resistant Staphylococcus aureus (MRSA) related pneumonia is of great clinical importance and still a great challenge. In this paper, we reported a novel kind of Au@Ag core-shell theranostic nanoparticles (NPs) conjugated with MRSA specific antibody on their surface. Compared with the raw Au@Ag NPs, these antibody modified NPs (AAMA NPs) showed 10.66 fold enhancement targeting to the MRSA in vitro. In vivo target efficacy was measured with rats bearing pneumonia induced by different pathogens. Computed tomography (CT) results revealed that these AAMA NPs had higher CT contrast enhancement (498 HU), than those of raw Au@Ag and Omnipaque (oth <100 HU). In addition, lesions labeled by AAMA NPs could be distinguished from lung parenchyma by taking advantage of spectra CT. Bio-distribution analysis confirmed that these AAMA NPs accumulated in the MRSA rich site. Both BAL and Elisa assays indicated that these AAMA NPs greatly alleviated the inflammation reaction by reducing bacterial proliferation and cytokine production. Pathological study showed that these NPs exerted negligible long term cytotoxicity in vivo. PMID:24836950

Huo, Da; Ding, Jing; Cui, Yi X; Xia, Lu Y; Li, Hui; He, Jian; Zhou, Zheng Y; Wang, Hong W; Hu, Yong

2014-08-01

360

An observational prospective study of topical acidified nitrite for killing methicillin-resistant Staphylococcus aureus (MRSA) in contaminated wounds  

PubMed Central

Background Endogenous nitric oxide (NO) kills bacteria and other organisms as part of the innate immune response. When nitrite is exposed to low pH, NO is generated and has been used as an NO delivery system to treat skin infections. We demonstrated eradication of MRSA carriage from wounds using a topical formulation of citric acid (4.5%) and sodium nitrite (3%) creams co-applied for 5 days to 15 wounds in an observational prospective pilot study of 8 patients. Findings Following treatment with topical citric acid and sodium nitrite, 9 of 15 wounds (60%) and 3 of 8 patients (37%) were cleared of infection. MRSA isolates from these patients were all sensitive to acidified nitrite in vitro compared to methicillin-sensitive S. aureus and a reference strain of MRSA. Conclusions Nitric oxide and acidified nitrite offer a novel therapy for control of MRSA in wounds. Wounds that were not cleared of infection may have been re-contaminated or the bioavailability of acidified nitrite impaired by local factors in the tissue.

2011-01-01

361

Use of ceramides and related products for childhood-onset eczema.  

PubMed

Atopic eczema or dermatitis (AD) is a chronically relapsing dermatosis associated with pruritus, sleep disturbance and impaired quality of life. AD affects 10 to 20% of school-aged children. The prevalence has increased two to three folds over the past three decades in industrialized countries and there is evidence to suggest that this prevalence is increasing. AD is frustrating to both patients and caregivers and can impose considerable financial impact on the families. The pruritus and sleep disturbance can be intractable and the disease has important physical and psychological implications. Filaggrin (filament-aggregating protein) has an important function in epidermal differentiation and barrier function. Null mutations within the filaggrin gene cause ichthyosis vulgaris and are major risk factors for developing AD. The affected skin of atopic individuals is deficient in natural moisturizing factors (derived from deiminated filaggrin peptides filaggrin) or ceramides (a family of lipid molecules, composed of sphingosine and a fatty acid, found in high concentrations within the cell membrane of cells in the stratum corneum). Avoidance of triggering factors, optimal skin care and topical corticosteroids are the mainstay of therapy for AD. There are two important dermatologic facets to its management, namely, preventive and therapeutic measures. Preventive measures refer to the frequent and proper application of skin moisturizers. When these preventive measures fail to control the disease exacerbation, therapeutic measures such as topical/systemic corticosteroids, antibiotics and immunomodulating agents may be required to control the skin inflammation. Proper moisturizer therapy can reduce the frequency of flares and the demand of topical corticosteroids or topical calcineurin inhibitors. Regular topical application of a moisturizer is the key in the management of patients with AD. Moisturizer therapy of childhood-onset AD is significantly complicated by the diversity of disease manifestations and by a variety of complex immune abnormalities. Recent advances in the understanding of the pathophysiological process of AD leads to the production of new moisturizers and topical skin products targeted to correct reduced amount of ceramides in the skin with ceramide and pseudoceramide products. However, many cosmetic products claimed to have these ingredients have no or limited studies to document their clinical efficacy. Recent studies have shown the therapeutic efficacy of several new compounds. This review provides an update on recent patents that could develop into novel therapeutics available to the clinical armamentarium for the management of the disease. PMID:23083072

Hon, Kam L; Leung, Alexander K C

2013-01-01

362

Medical and health economic evaluation of prevention- and control measures related to MRSA infections or -colonisations at hospitals  

PubMed Central

Introduction Methicillin-resistant Staphylococcus aureus (MRSA) are dangerous agents of nosocomial infections. In 2007 the prevalence of MRSA is 20.3% in Germany (Oxacilline-resistance according to EUCAST-criteria [EUCAST = European Committee on Antimicrobial Susceptibility Testing]). Objectives Which measurements are effective in the prevention and control of MRSA-infections in the hospital? How effective are contact precautions, screening, decolonisation, education and surveillance? Which recommendations can be given to health care politics on the basis of cost-effectiveness studies? Have there been any adverse effects on patients and clinical staff? What kind of liability problems exist? Methods Based on a systematic review of the literature studies are included which have been published in German or English language since 2004. Results 1,508 articles have been found. After having surveyed the full text, 33 medical, eight economic and four ethical/juridical studies are included for the Health Technology Assessment (HTA) report. The key result of the HTA report is that different measurements are effective in the prevention and control of MRSA-infections in hospitals, though the majority of the studies has a low quality. Effective are the conduction of differentiated screening measurements if they take into account the specific endemic situation, the use of antibiotic-control programs and the introduction and control of hygienic measurements. The break even point of preventive and control measurements cannot be defined because the study results differ too much. In the future it has to be more considered that MRSA-infections and contact precautions lead to a psycho-social strain for patients. Discussion It is hardly possible to describe causal efficacies because in the majority of the studies confounders are not sufficiently considered. In many cases bundles of measurements have been established but not analyzed individually. The internal and external validity of the studies is too weak to evaluate single interventions. Hygienic measurements prove to be effective in combination with other measurements. But it cannot be said which of the single measurements (gloves, washing hands, wearing gowns or masks) has the strongest effect on the reduction of MRSA. It is irritating that there are high differences in the compliance concerning hand hygiene between different studies. A general decolonisation is questionable for different reasons: first because of the side-effects for patients, second because of the high rate of spontaneous remissions in the untreated control group, third because of the differentiated process from colonisation to infection. Severalfold Hawthorne effects have been reported. One of them is that the competition between hospitals to reduce MRSA-rates leads already to a reduction. Conclusions It is evident that selective screening programs of risk patients considering the particular MRSA-prevalence are of use. The application of rapid tests seems to be only recommendable for risk patients and a high MRSA-prevalence. The improvement of the compliance of hand hygiene should be the basis of any prevention strategy. Training of staff members (with feedback mechanisms) is effective to improve compliance and to optimise the use of antibiotics. Antibiotic management programs are effective as well. Obviously multimodal approaches can lead to overadditive effects. Therefore the catalogue of preventive and control measurements has to be further evaluated. Good cost-efficacy studies are missing in Germany. The psychosocial effects of MRSA-infections are not researched in Germany. There is only punctual information on the risk management of hospitals.

Korczak, Dieter; Schoffmann, Christine

2010-01-01

363

Tetarimycin A, an MRSA-active antibiotic identified through induced expression of environmental DNA gene clusters.  

PubMed

The propagation of DNA extracted directly from environmental samples in laboratory-grown bacteria provides a means to study natural products encoded in the genomes of uncultured bacteria. However, gene silencing often hampers the functional characterization of gene clusters captured on environmental DNA clones. Here we show that the overexpression of transcription factors found in sequenced environmental DNA-derived biosynthetic gene clusters, in conjunction with traditional culture-broth extract screening, can be used to identify new bioactive secondary metabolites from otherwise-silent gene clusters. Tetarimycin A, a tetracyclic methicillin-resistant Staphylococcus aureus (MRSA)-active antibiotic, was isolated from the culture-broth extract of Streptomyces albus cultures cotransformed with an environmentally derived type-II polyketide biosynthetic gene cluster and its pathway-specific Streptomyces antibiotic regulatory protein (SARP) cloned under the control of the constitutive ermE* promoter. PMID:23157252

Kallifidas, Dimitris; Kang, Hahk-Soo; Brady, Sean F

2012-12-01

364

Telavancin for the treatment of nosocomial pneumonia caused by methicillin-resistant Staphylococcus aureus (MRSA)  

PubMed Central

Telavancin is a bactericidal lipoglycopeptide antibiotic that is structurally related to vancomycin. It demonstrates in vitro activity against a variety of Gram-positive pathogens including, but not limited to, methicillin-resistant Staphylococcus aureus (MRSA). Telavancin is currently FDA-approved for the treatment of complicated skin and skin-structure infections. Recently, two randomized clinical trials demonstrated the efficacy and safety of telavancin compared to vancomycin for the treatment of nosocomial pneumonia. Overall, telavancin has a favorable safety profile. However, mild gastrointestinal disturbances and reversible increases in serum creatinine were observed in clinical studies. Additional clinical studies are needed to evaluate telavancin’s efficacy and safety in comparison to other antistaphylococcal agents for the treatment of infections such as bacteremia and endocarditis.

Hooper, Candace Y; Smith, Winter J

2012-01-01

365

Tetarimycin A, an MRSA active antibiotic identified through induced expression of environmental DNA gene clusters  

PubMed Central

The propagation of DNA extracted directly from environmental samples in laboratory grown bacteria provides a means to study natural products encoded in the genomes of uncultured bacteria. Gene silencing however, often hampers functional characterization of gene clusters captured on environmental DNA clones. Here we show that the over-expression of transcription factors found in sequenced environmental DNA derived biosynthetic gene clusters, in conjunction with traditional culture broth extract screening, can be used to identify new bioactive secondary metabolites from otherwise silent gene clusters. Tetarimycin A, a tetracylic methicillin resistant Staphylococcus aureus (MRSA) active antibiotic, was isolated from the culture broth extract of Streptomyces albus cultures co-tranformed with an environmentally-derived type II polyketide biosynthetic gene cluster and its pathway-specific SARP (Streptomyces antibiotic regulatory protein) regulator protein cloned under the control of the constitutive ermE* promoter.

Kallifidas, Dimitris; Kang, Hahk-Soo

2012-01-01

366

An Outbreak of Severe Infections with Community-Acquired MRSA Carrying the Panton-Valentine Leukocidin Following Vaccination  

PubMed Central

Background Infections with community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) are emerging worldwide. We investigated an outbreak of severe CA-MRSA infections in children following out-patient vaccination. Methods and Findings We carried out a field investigation after adverse events following immunization (AEFI) were reported. We reviewed the clinical data from all cases. S. aureus recovered from skin infections and from nasal and throat swabs were analyzed by pulse-field gel electrophoresis, multi locus sequence typing, PCR and microarray. In May 2006, nine children presented with AEFI, ranging from fatal toxic shock syndrome, necrotizing soft tissue infection, purulent abscesses, to fever with rash. All had received a vaccination injection in different health centres in one District of Ho Chi Minh City. Eight children had been vaccinated by the same health care worker (HCW). Deficiencies in vaccine quality, storage practices, or preparation and delivery were not found. Infection control practices were insufficient. CA-MRSA was cultured in four children and from nasal and throat swabs from the HCW. Strains from children and HCW were indistinguishable. All carried the Panton-Valentine leukocidine (PVL), the staphylococcal enterotoxin B gene, the gene complex for staphylococcal-cassette-chromosome mec type V, and were sequence type 59. Strain HCM3A is epidemiologically unrelated to a strain of ST59 prevalent in the USA, although they belong to the same lineage. Conclusions We describe an outbreak of infections with CA-MRSA in children, transmitted by an asymptomatic colonized HCW during immunization injection. Consistent adherence to injection practice guidelines is needed to prevent CA-MRSA transmission in both in- and outpatient settings.

Chi Thuong, Tang; Dac Tho, Nguyen; Thi Hoa, Ngo; Minh Phuong, Nguyen Thi; Van Tuan, Le; Song Diep, To; Lindsay, Jodi; The Dung, Nguyen; Van Cam, Bach; Quoc Thinh, Le; Thanh Hai, Le; Dieu Linh, Le; Campbell, James; Kim Tien, Nguyen Thi; Vinh Chau, Nguyen Van; Cockfield, Joshua; Truong Giang, Le; Van Nghiem, Phan; Hoang Son, Le; Tan Son, Huynh; Van Phung, Le; Counahan, Megan; Bentsi-Enchill, Adwoa; Brown, Richard; Simmerman, James; Tran Chinh, Nguyen; Tinh Hien, Tran; Farrar, Jeremy; Schultsz, Constance

2007-01-01

367

Epidemiology of mecA-Methicillin Resistant Staphylococcus aureus (MRSA) in Iran: A Systematic Review and Meta-analysis  

PubMed Central

Objective(s) Staphylococcus aureus (S. aureus) is a prevalent pathogen worldwide. Methicillin resistant S. aureus (MRSA), which is usually multi-resistant in hospitals, has been a daunting challenge for clinicians for more than half a century. The aim of this systematic review and meta-analysis is to determine the relative frequency (R.F.) of MRSA in different regions of Iran. Materials and Methods Search terms “Staphylococcus aureus”, “Methicillin”, “mecA” and “Iran” were used in PubMed, Scirus and Google Scholar. Two Persian scientific search engines and ten recent national congresses were also explored. Articles/abstracts, which used clinical specimens and had done PCR to detect the mecA gene, were included in this review. Comprehensive Meta-Analysis and Meta-Analyst software were used for statistical analysis. Results Out of 2690 results found in the mentioned databases, 48 articles were included in the final analysis. These studies were done in Ahvaz, Falavarjan, Fasa, Gorgan, Hamedan, Isfehan, Kashan, Mashhad, Sanandaj, Shahrekord, Shiraz, Tabriz, Tehran and Tonekabon. Pooled estimation of 7464 S. aureus samples showed that 52.7%±4.7 (95% confidence interval [CI]) of strains were mecA positive. MRSA R.F. in different studies varied from 20.48% to 90% in Isfehan and Tehran, respectively. We found a moderate heterogeneity (I2= 48.5%) of MRSA R.F. among studies conducted in Tehran (ranging from 28.88% to 90%, mean 52.7% [95% CI: 46.6%±0.58.8%]). Conclusion According to the results of this study, MRSA R.F. in Iran is in the high range. Thus, measures should be taken to keep the emergence and transmission of these strains to a minimum.

Askari, Emran; Soleymani, Fatemeh; Arianpoor, Arash; Tabatabai, Seyed Meghdad; Amini, Aminreza; NaderiNasab, Mahboobeh

2012-01-01

368

Emergence of Hospital- and Community-Associated Panton-Valentine Leukocidin-Positive Methicillin-Resistant Staphylococcus aureus Genotype ST772-MRSA-V in Ireland and Detailed Investigation of an ST772-MRSA-V Cluster in a Neonatal Intensive Care Unit  

PubMed Central

Sequence type 22 (ST22) methicillin-resistant Staphylococcus aureus (MRSA) harboring staphylococcal cassette chromosome mec (SCCmec) IV (ST22-MRSA-IV) has predominated in Irish hospitals since the late 1990s. Six distinct clones of community-associated MRSA (CA-MRSA) have also been identified in Ireland. A new strain of CA-MRSA, ST772-MRSA-V, has recently emerged and become widespread in India and has spread into hospitals. In the present study, highly similar MRSA isolates were recovered from seven colonized neonates in a neonatal intensive care unit (NICU) in a maternity hospital in Ireland during 2010 and 2011, two colonized NICU staff, one of their colonized children, and a NICU environmental site. The isolates exhibited multiantibiotic resistance, spa type t657, and were assigned to ST772-MRSA-V by DNA microarray profiling. All isolates encoded resistance to macrolides [msr(A) and mpb(BM)] and aminoglycosides (aacA-aphD and aphA3) and harbored the Panton-Valentine leukocidin toxin genes (lukF-PV and lukS-PV), enterotoxin genes (sea, sec, sel, and egc), and one of the immune evasion complex genes (scn). One of the NICU staff colonized by ST772-MRSA-V was identified as the probable index case, based on recent travel to India. Seven additional hospital and CA-ST772-MRSA-V isolates recovered from skin and soft tissue infections in Ireland between 2009 and 2011 exhibiting highly similar phenotypic and genotypic characteristics to the NICU isolates were also identified. The clinical details of four of these patients revealed connections with India through ethnic background or travel. Our study indicates that hospital-acquired and CA-ST772-MRSA-V is currently emerging in Ireland and may have been imported from India on several occasions.

Shore, Anna C.; Corcoran, Suzanne; Tecklenborg, Sarah; Coleman, David C.; O'Connell, Brian

2012-01-01

369

Artesunate has its enhancement on antibacterial activity of ?-lactams via increasing the antibiotic accumulation within methicillin-resistant Staphylococcus aureus (MRSA).  

PubMed

Methicillin-resistant Staphylococcus aureus (MRSA) has now emerged as a predominant and serious pathogen because of its resistance to a large group of antibiotics, leading to high morbidity and mortality. Therefore, to develop new agents against resistance is urgently required. Previously, artesunate (AS) was found to enhance the antibacterial effect of ?-lactams against MRSA. In this study, AS was first found to increase the accumulation of antibiotics (daunorubicin and oxacillin) within MRSA by laser confocal microscopy and liquid chromatography-tandem MS method, suggesting the increased antibiotics accumulation might be related to the enhancement of AS on antibiotics. Furthermore, AS was found not to destroy the cell structure of MRSA by transmission electron microscope. AS was found to inhibit gene expressions of important efflux pumps such as NorA, NorB and NorC, but not MepA, SepA and MdeA. In conclusion, our results showed that AS was capable of enhancing the antibacterial activity of ?-lactams via increasing antibiotic accumulations within MRSA through inhibiting gene expressions of efflux pumps such as NorA, NorB and NorC, but did not destroy the cell structure of MRSA. AS could be further investigated as a candidate drug for treatment of MRSA infection. PMID:23549351

Jiang, Weiwei; Li, Bin; Zheng, Xinchuan; Liu, Xin; Pan, Xichun; Qing, Rongxin; Cen, Yanyan; Zheng, Jiang; Zhou, Hong

2013-06-01

370

[Effect of pharmacists' intervention on the antibiotic therapy for the methicillin-resistant Staphylococcus aureus (MRSA) infectious diseases in the intensive care unit].  

PubMed

Pharmacists are providing pharmaceutical care in general wards, but it is still not common in the intensive care unit (ICU). However, we have worked in ICU, and recommended the rational dosage regimen of the antibiotics to the physicians during the treatment period. Especially, the patients who were infected with methicillin-resistant Staphylococcus aureus (MRSA) in ICU should be provided appropriate antibiotic therapy, otherwise they have a poor prognosis. The aim of this study is to evaluate usefulness of the pharmacists' intervention on the antibiotic therapy for MRSA infectious diseases in the ICU. We investigated retrospectively the period of anti MRSA drugs administration, the medical cost, which includes cost of anti MRSA drugs and hospital charge, and the initial trough concentration of vancomycin (VCM). The patients with MRSA pneumonia were classified into two groups according to the pharmacists' intervention. The number of the patients who the pharmacists performed dosage regimen of anti MRSA drug was 11 (intervention group) and that of the patients who the pharmacists performed no intervention was 47 (control group). The average period of administration of anti MRSA drugs in the intervention group was significantly decreased in 5 days. Furthermore, if the pharmacists performed dosage regimen of anti MRSA drug to the patients in control group, the medical cost of 10 million yen would be saved. The initial trough concentrations of VCM were not significantly different between two groups. However, the achievement rates are 75.0% in intervention group and 66.7% in control group, if the goal of trough level of VCM is set from 5 to 15 µg/ml. Moreover, there are 75.0% in intervention group and 20.8% in control group, if the goal of trough level of VCM is set from 10 to 20 µg/ml, which is significantly different between the two groups. Therefore, it was suggested that the pharmacists in the ICU contributed to optimize the anti MRSA therapy and reduce the medical cost. PMID:21467796

Imaura, Masaharu; Kohata, Yuji; Kobayashi, Koutarou; Takahashi, Hiroyuki; Yokoyama, Haruko; Akase, Tomohide; Yamada, Yasuhiko

2011-04-01

371

Effect of probiotic mix (Bifidobacterium bifidum, Bifidobacterium lactis, Lactobacillus acidophilus) in the primary prevention of eczema: a double-blind, randomized, placebo-controlled trial.  

PubMed

Controversy exists regarding the preventive effect of probiotics on the development of eczema or atopic dermatitis. We investigated whether supplementation of probiotics prevents the development of eczema in infants at high risk. In a randomized, double-blind, placebo-controlled trial, 112 pregnant women with a family history of allergic diseases received a once-daily supplement, either a mixture of Bifidobacterium bifidum BGN4, B. lactis AD011, and Lactobacillus acidophilus AD031, or placebo, starting at 4-8 wks before delivery and continuing until 6 months after delivery. Infants were exclusively breast-fed during the first 3 months, and were subsequently fed with breastmilk or cow's milk formula from 4 to 6 months of age. Clinical symptoms of the infants were monitored until 1 yr of age, when the total and specific IgE against common food allergens were measured. A total of 68 infants completed the study. The prevalence of eczema at 1 yr in the probiotic group was significantly lower than in the placebo group (18.2% vs. 40.0%, p=0.048). The cumulative incidence of eczema during the first 12 months was reduced significantly in probiotic group (36.4% vs. 62.9%, p=0.029); however, there was no difference in serum total IgE level or the sensitization against food allergens between the two groups. Prenatal and postnatal supplementation with a mixture of B. bifidum BGN4, B. lactis AD011, and L. acidophilus AD031 is an effective approach in preventing the development of eczema in infants at high risk of allergy during the first year of life. PMID:19840300

Kim, Ji Yeun; Kwon, Jung Hyun; Ahn, So Hyun; Lee, Sang Il; Han, Young Shin; Choi, Young Ok; Lee, Soo Young; Ahn, Kang Mo; Ji, Geun Eog

2010-03-01

372

Investigating international time trends in the incidence and prevalence of atopic eczema 1990-2010: a systematic review of epidemiological studies.  

PubMed

The prevalence of atopic eczema has been found to have increased greatly in some parts of the world. Building on a systematic review of global disease trends in asthma, our objective was to study trends in incidence and prevalence of atopic eczema. Disease trends are important for health service planning and for generating hypotheses regarding the aetiology of chronic disorders. We conducted a systematic search for high quality reports of cohort, repeated cross-sectional and routine healthcare database-based studies in seven electronic databases. Studies were required to report on at least two measures of the incidence and/or prevalence of atopic eczema between 1990 and 2010 and needed to use comparable methods at all assessment points. We retrieved 2,464 citations, from which we included 69 reports. Assessing global trends was complicated by the use of a range of outcome measures across studies and possible changes in diagnostic criteria over time. Notwithstanding these difficulties, there was evidence suggesting that the prevalence of atopic eczema was increasing in Africa, eastern Asia, western Europe and parts of northern Europe (i.e. the UK). No clear trends were identified in other regions. There was inadequate study coverage worldwide, particularly for repeated measures of atopic eczema incidence. Further epidemiological work is needed to investigate trends in what is now one of the most common long-term disorders globally. A range of relevant measures of incidence and prevalence, careful use of definitions and description of diagnostic criteria, improved study design, more comprehensive reporting and appropriate interpretation of these data are all essential to ensure that this important field of epidemiological enquiry progresses in a scientifically robust manner. PMID:22808063

Deckers, Ivette A G; McLean, Susannah; Linssen, Sanne; Mommers, Monique; van Schayck, C P; Sheikh, Aziz

2012-01-01

373

Impact of Anthelminthic Treatment in Pregnancy and Childhood on Immunisations, Infections and Eczema in Childhood: A Randomised Controlled Trial  

PubMed Central

Background Helminth infections may modulate immune responses to unrelated pathogens and allergens; these effects may commence prenatally. We addressed the hypothesis that anthelminthic treatment in pregnancy and early childhood would improve responses to immunisation and modulate disease incidence in early childhood with both beneficial and detrimental effects. Methods and Findings A randomised, double-blind, placebo-controlled trial was conducted in Entebbe, Uganda [ISRCTN32849447]. In three independent randomisations, 2507 pregnant women were allocated to receive single-dose albendazole or placebo, and praziquantel or placebo; 2016 of their offspring were randomised to receive quarterly single-dose albendazole or placebo from age 15 months to 5 years. Primary outcomes were post-immunisation recall responses to BCG and tetanus antigens, and incidence of malaria, diarrhoea, and pneumonia; incidence of eczema was an important secondary outcome. Analysis was by intention-to-treat. Of 2345 live births, 1622 (69%) children remained in follow-up at age 5 years. 68% of mothers at enrolment, and 11% of five-year-olds, had helminth infections. Maternal hookworm and Schistosoma mansoni were effectively treated by albendazole and praziquantel, respectively; and childhood hookworm and Ascaris by quarterly albendazole. Incidence rates of malaria, diarrhoea, pneumonia, and eczema were 34, 65, 10 and 5 per 100 py, respectively. Albendazole during pregnancy caused an increased rate of eczema in the children (HR 1.58 (95% CI 1.15–2.17), p?=?0.005). Quarterly albendazole during childhood was associated with reduced incidence of clinical malaria (HR 0.85 (95% CI 0.73–0.98), p?=?0.03). There were no consistent effects of the interventions on any other outcome. Conclusions Routine use of albendazole in pregnancy may not always be beneficial, even in tropical developing countries. By contrast, regular albendazole treatment in preschool children may have an additional benefit for malaria control where helminths and malaria are co-endemic. Given the low helminth prevalence in our children, the effect of albendazole on malaria is likely to be direct. Trial registration Current Controlled Trials ISRCTN32849447

Mawa, Patrice A.; Nampijja, Margaret; Muhangi, Lawrence; Kihembo, Macklyn; Lule, Swaib A.; Rutebarika, Diana; Apule, Barbara; Akello, Florence; Akurut, Hellen; Oduru, Gloria; Naniima, Peter; Kizito, Dennison; Kizza, Moses; Kizindo, Robert; Tweyongere, Robert; Alcock, Katherine J.; Muwanga, Moses; Elliott, Alison M.

2012-01-01

374

Cord Blood 25(OH)-Vitamin D Deficiency and Childhood Asthma, Allergy and Eczema: The COPSAC2000 Birth Cohort Study  

PubMed Central

Background Epidemiological studies have suggested an association between maternal vitamin D dietary intake during pregnancy and risk of asthma and allergy in the offspring. However, prospective clinical studies on vitamin D measured in cord blood and development of clinical end-points are sparse. Objective To investigate the interdependence of cord blood 25-hydroxyvitamin D (25(OH)-Vitamin D) level and investigator-diagnosed asthma- and allergy-related conditions during preschool-age. Methods Cord blood 25(OH)-Vitamin D level was measured in 257 children from the Copenhagen Prospective Studies on Asthma in Childhood (COPSAC2000) at-risk mother-child cohort. Troublesome lung symptoms (TROLS), asthma, respiratory infections, allergic rhinitis, and eczema, at age 0–7 yrs were diagnosed exclusively by the COPSAC pediatricians strictly adhering to predefined algorithms. Objective assessments of lung function and sensitization were performed repeatedly from birth. Results After adjusting for season of birth, deficient cord blood 25(OH)-Vitamin D level (<50 nmol/L) was associated with a 2.7-fold increased risk of recurrent TROLS (HR?=?2.65; 95% CI?=?1.02–6.86), but showed no association with respiratory infections or asthma. We saw no association between cord blood 25(OH)-Vitamin D level and lung function, sensitization, rhinitis or eczema. The effects were unaffected from adjusting for multiple lifestyle factors. Conclusion Cord blood 25(OH)-Vitamin D deficiency associated with increased risk of recurrent TROLS till age 7 years. Randomized controlled trials of vitamin D supplementation during pregnancy are needed to prove causality.

Chawes, Bo L.; B?nnelykke, Klaus; Jensen, Pia F.; Schoos, Ann-Marie M.; Heickendorff, Lene; Bisgaard, Hans

2014-01-01

375

The Clinical Efficacy of Mometasone Furoate in Multi-Lamellar Emulsion for Eczema: A Double-blinded Crossover Study  

PubMed Central

Background Topical application of corticosteroids also has an influence on skin barrier impairment. Physiological lipid mixtures, such as multi-lamellar emulsion (MLE) containing a natural lipid component leads to effective recovery of the barrier function. Objective The purpose of this study was to conduct an evaluation of the therapeutic efficacy and skin barrier protection of topical mometasone furoate in MLE. Methods A multi-center randomized, double-blind, controlled study was performed to assess the efficacy and safety of mometasone furoate cream in MLE for Korean patients with eczema. The study group included 175 patients with eczema, who applied either mometasone furoate in MLE cream or methylprednisolone aceponate cream for 2 weeks. Treatment efficacy was evaluated using the physician's global assessment of clinical response (PGA), trans-epidermal water loss (TEWL), and visual analogue scale (VAS) for pruritus. Patients were evaluated using these indices at days 4, 8, and 15. Results Comparison of PGA score, TEWL, and VAS score at baseline with those at days 4, 8, and 15 of treatment showed a significant improvement in both groups. Patients who applied mometasone furoate in MLE (74.8%) showed better results (p<0.05) than those who applied methylprednisolone aceponate (47.8%). The TEWL improvement ratio was higher in the mometasone furoate in MLE group than that in the methylprednisolone aceponate group, and VAS improvement was also better in the mometasone furoate in MLE group. Conclusion Mometasone furoate in MLE has a better therapeutic efficacy as well as less skin barrier impairment than methylprednisolone aceponate.

Kim, Duk Han; Lee, Hyun Jong; Park, Chun Wook; Kim, Kyu Han; Lee, Kwang Hoon; Ro, Byung In

2013-01-01

376

Antibacterial activity of stilbene oligomers against vancomycin-resistant Enterococci (VRE) and methicillin-resistant Staphylococcus aureus (MRSA) and their synergism with antibiotics.  

PubMed

Two resveratrol trimers, gnemonol B isolated from Gnetum gnemon and gnetin E obtained from the Gnetum species, were found to exhibit strong antibacterial activities against vancomycin-resistant Enterococci (VRE) and methicillin-resistant Staphylococcus aureus (MRSA). The MIC values of gnemonol B against five strains of VRE and nine strains of MRSA were 12.5 and 6.25 microg/ml, respectively. The MIC values of gnetin E against five strains of VRE and nine strains of MRSA ranged from 12.5 to 25microg/ml. These compounds also showed synergistic effects when used in combination with commercially available antibiotics according to the evaluation method using FIC indices. These findings suggested that the application of the test compounds alone or in combination with antibiotics might be useful in controlling and treating VRE and MRSA infections PMID:17408003

Sakagami, Yoshikazu; Sawabe, Akiyoshi; Komemushi, Sadao; All, Zulfiqar; Tanaka, Toshiyuki; Iliya, Ibrahim; Iinuma, Munekazu

2007-03-01

377

Evaluation of the nasal microbiota in slaughter-age pigs and the impact on nasal methicillin-resistant Staphylococcus aureus (MRSA) carriage  

PubMed Central

Background The nasal microbiota of pigs has been poorly assessed but could play a role in carriage of important microorganisms such as methicillin-resistant Staphylococcus aureus (MRSA). The objectives of this study were to describe the nasal microbiota in slaughter age pigs, to evaluate the impact of farm management on the nasal microbiota and to provide a preliminary assessment of the influence of the microbiota on MRSA carriage. Results Nasal swabs were collected from five MRSA positive and eight MRSA negative pigs on one farm that used a liquid feeding system and routine tylosin treatment, and seven MRSA negative pigs from an antibiotic-free farm that used conventional feeding. A total of 946310 sequences passed all quality control filters. The number of sequences per sample ranged from 4307 to 165656 (mean 56092, SD 40007). CatchAll analysis of richness predicted a mean of 1749 OTUs (range 213–3736, SD 996). Overall, 6291 OTUs were identified, yet 5125 (81%) were identified less than 10 times and the 12 most abundant OTUs accounted for 80.7% of sequences. Proteobacteria predominated in all but two samples. Liquid-fed/tylosin-exposed pigs had significantly lower relative abundances of Verrucomicrobia (P?=?0.004), Fibrobacteres (P?=?<0.0001) and sequences unclassified at the phylum level (P?=?0.028). When comparing only liquid-fed pigs, MRSA carriers had significantly more Bacteroidetes (P?=?0.037) than MRSA negative pigs. 124 genera were identified, with Moraxella accounting for 35.4% of sequences. In the Jaccard index tree, five of eight MRSA positive pigs clustered closely together, as did six of the seven conventionally-fed pigs. A significant difference was identified between conventional and liquid-fed pigs using parsimony test with the Jaccard (P?MRSA positive and negative pigs (P?=?0.133 and 0.175). OTUs belonging to Firmicutes were the main indicators of MRSA negative pigs, including Lactobacillus and another Lactobacillaceae and Staphylococcus. Conclusions Farm management can influence the nasal microbiota in pigs, but no impact of the microbiota on MRSA carriage was identified. Studies that further define the impact of management on the microbiota, and the impact of the microbiota on pathogen carriage are indicated.

2014-01-01

378

Complete Genome Sequence of Staphylococcus aureus XN108, an ST239-MRSA-SCCmec III Strain with Intermediate Vancomycin Resistance Isolated in Mainland China  

PubMed Central

ST239-MRSA-SCCmec III (ST239, sequence type 239; MRSA, methicillin-resistant Staphylococcus aureus; SCCmec III, staphylococcal cassette chromosome mec type III) is the most predominant clone of hospital-acquired methicillin-resistant S. aureus in mainland China. We report here the complete genome sequence of XN108, the first vancomycin-intermediate S. aureus strain isolated from a steam-burned patient with a wound infection.

Zhang, Xia; Xu, Xiaomeng; Yuan, Wenchang; Hu, Qiwen; Shang, Weilong; Hu, Xiaomei

2014-01-01

379

Comparison of spa Types, SCCmec Types and Antimicrobial Resistance Profiles of MRSA Isolated from Turkeys at Farm, Slaughter and from Retail Meat Indicates Transmission along the Production Chain  

PubMed Central

The prevalence of MRSA in the turkey meat production chain in Germany was estimated within the national monitoring for zoonotic agents in 2010. In total 22/112 (19.6%) dust samples from turkey farms, 235/359 (65.5%) swabs from turkey carcasses after slaughter and 147/460 (32.0%) turkey meat samples at retail were tested positive for MRSA. The specific distributions of spa types, SCCmec types and antimicrobial resistance profiles of MRSA isolated from these three different origins were compared using chi square statistics and the proportional similarity index (Czekanowski index). No significant differences between spa types, SCCmec types and antimicrobial resistance profiles of MRSA from different steps of the German turkey meat production chain were observed using Chi-Square test statistics. The Czekanowski index which can obtain values between 0 (no similarity) and 1 (perfect agreement) was consistently high (0.79–0.86) for the distribution of spa types and SCCmec types between the different processing stages indicating high degrees of similarity. The comparison of antimicrobial resistance profiles between the different process steps revealed the lowest Czekanowski index values (0.42–0.56). However, the Czekanowski index values were substantially higher than the index when isolates from the turkey meat production chain were compared to isolates from wild boar meat (0.13–0.19), an example of a separated population of MRSA used as control group. This result indicates that the proposed statistical method is valid to detect existing differences in the distribution of the tested characteristics of MRSA. The degree of similarity in the distribution of spa types, SCCmec types and antimicrobial resistance profiles between MRSA isolates from different process stages of turkey meat production may reflect MRSA transmission along the chain.

Vossenkuhl, Birgit; Brandt, Jorgen; Fetsch, Alexandra; Kasbohrer, Annemarie; Kraushaar, Britta; Alt, Katja; Tenhagen, Bernd-Alois

2014-01-01

380

Comparison of spa Types, SCCmec Types and Antimicrobial Resistance Profiles of MRSA Isolated from Turkeys at Farm, Slaughter and from Retail Meat Indicates Transmission along the Production Chain.  

PubMed

The prevalence of MRSA in the turkey meat production chain in Germany was estimated within the national monitoring for zoonotic agents in 2010. In total 22/112 (19.6%) dust samples from turkey farms, 235/359 (65.5%) swabs from turkey carcasses after slaughter and 147/460 (32.0%) turkey meat samples at retail were tested positive for MRSA. The specific distributions of spa types, SCCmec types and antimicrobial resistance profiles of MRSA isolated from these three different origins were compared using chi square statistics and the proportional similarity index (Czekanowski index). No significant differences between spa types, SCCmec types and antimicrobial resistance profiles of MRSA from different steps of the German turkey meat production chain were observed using Chi-Square test statistics. The Czekanowski index which can obtain values between 0 (no similarity) and 1 (perfect agreement) was consistently high (0.79-0.86) for the distribution of spa types and SCCmec types between the different processing stages indicating high degrees of similarity. The comparison of antimicrobial resistance profiles between the different process steps revealed the lowest Czekanowski index values (0.42-0.56). However, the Czekanowski index values were substantially higher than the index when isolates from the turkey meat production chain were compared to isolates from wild boar meat (0.13-0.19), an example of a separated population of MRSA used as control group. This result indicates that the proposed statistical method is valid to detect existing differences in the distribution of the tested characteristics of MRSA. The degree of similarity in the distribution of spa types, SCCmec types and antimicrobial resistance profiles between MRSA isolates from different process stages of turkey meat production may reflect MRSA transmission along the chain. PMID:24788143

Vossenkuhl, Birgit; Brandt, Jörgen; Fetsch, Alexandra; Käsbohrer, Annemarie; Kraushaar, Britta; Alt, Katja; Tenhagen, Bernd-Alois

2014-01-01

381

Large screening of CA-MRSA among Staphylococcus aureus colonizing healthy young children living in two areas (urban and rural) of Portugal  

Microsoft Academic Search

BACKGROUND: The incidence of pediatric infections due to community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA), including children with no identifiable risk factors, has increased worldwide in the last decade. This suggests that healthy children may constitute a reservoir of MRSA in the community. In this study, nested within a larger one on nasopharyngeal ecology, we aimed to: (i) evaluate the prevalence of

Débora A Tavares; Raquel Sá-Leão; Maria Miragaia; Hermínia de Lencastre

2010-01-01

382

Temporal effects of antibiotic use and hand rub consumption on the incidence of MRSA and Clostridium difficile  

Microsoft Academic Search

Objectives: The aim of this study was to determine the temporal relation between the use of antibiotics and alcohol-based hand rubs (ABHRs) and the incidence of methicillin-resistant Staphylococcus aureus (MRSA) and Clostridium difficile. Methods: An interventional time-series analysis was performed to evaluate the impact of two pro- motion campaigns on the consumption of ABHRs and to assess their effect on

Nathalie Vernaz; Hugo Sax; Didier Pittet; Pascal Bonnabry; Jacques Schrenzel; Stephan Harbarth

2008-01-01

383

A Novel Core Genome-Encoded Superantigen Contributes to Lethality of Community-Associated MRSA Necrotizing Pneumonia  

PubMed Central

Bacterial superantigens (SAg) stimulate T-cell hyper-activation resulting in immune modulation and severe systemic illnesses such as Staphylococcus aureus toxic shock syndrome. However, all known S. aureus SAgs are encoded by mobile genetic elements and are made by only a proportion of strains. Here, we report the discovery of a novel SAg staphylococcal enterotoxin-like toxin X (SElX) encoded in the core genome of 95% of phylogenetically diverse S. aureus strains from human and animal infections, including the epidemic community-associated methicillin-resistant S. aureus (CA-MRSA) USA300 clone. SElX has a unique predicted structure characterized by a truncated SAg B-domain, but exhibits the characteristic biological activities of a SAg including V?-specific T-cell mitogenicity, pyrogenicity and endotoxin enhancement. In addition, SElX is expressed by clinical isolates in vitro, and during human, bovine, and ovine infections, consistent with a broad role in S. aureus infections of multiple host species. Phylogenetic analysis suggests that the selx gene was acquired horizontally by a progenitor of the S. aureus species, followed by allelic diversification by point mutation and assortative recombination resulting in at least 17 different alleles among the major pathogenic clones. Of note, SElX variants made by human- or ruminant-specific S. aureus clones demonstrated overlapping but distinct V? activation profiles for human and bovine lymphocytes, indicating functional diversification of SElX in different host species. Importantly, SElX ma