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Sample records for eczema herpeticum mrsa

  1. Treatment of Recurrent Eczema Herpeticum in Pregnancy With Acyclovir

    PubMed Central

    Baker, David A.

    1996-01-01

    Background: Eczema herpeticum is an uncommon manifestation of an infection with herpes simplex virus (HSV). The disease is primarily seen in patients with histories of atopic eczema. Eczema herpeticum may be a life-threatening illness, but the mortality is felt to be <10% with modern antiviral and antibacterial agents. The use of acyclovir for other viral infections secondary to herpesvirus in pregnancy has been well documented. The authors now present a case report of eczema herpeticum treated with acyclovir during pregnancy. Case: A patient with a history of eczema herpeticum presented in pregnancy with a recurrence. She was successfully treated with intravenous (IV) acyclovir with good maternal and fetal outcome. Conclusion: Acyclovir may be utilized in pregnancy for several manifestations of HSV including eczema herpeticum. PMID:18476099

  2. Comparative Proteomic Profiling of Atopic Dermatitis Patients Based on History of Eczema Herpeticum Infection and Staphylococcus aureus Colonization

    PubMed Central

    Broccardo, Carolyn J; Mahaffey, Spencer; Schwarz, John; Wruck, Lisa; David, Gloria; Schlievert, Patrick M; Reisdorph, Nichole A; Leung, Donald YM

    2010-01-01

    Background Atopic dermatitis is the most common inflammatory skin disorder in the general population worldwide and the majority of patients are colonized with Staphylococcus aureus. Eczema herpeticum is a disseminated herpes simplex virus infection that occurs in a small subset of patients. Objectives The goal was to conduct proteomic profiling of atopic dermatitis patients based on Staphylococcus aureus colonization status and history of eczema herpeticum. We hoped to identify new biomarkers for improved diagnosis and prediction of eczema herpeticum and Staphylococcus aureus susceptibility, and to generate new hypotheses regarding disease pathogenesis. Methods Skin taping was performed on nonlesional skin of non-atopic controls and on lesional and nonlesional skin of atopic dermatitis patients. Subjects were classified according to history of eczema herpeticum and Staphylococcus aureus colonization. Proteins were analyzed using mass spectrometry; diagnostic groups were compared for statistically significant differences in protein expression. Results Proteins related to the skin barrier (filaggrin-2, corneodesmosin, desmoglein-1, desmocollin-1, and transglutaminase-3) and generation of natural moisturizing factor (arginase-1, caspase-14, gamma-glutamyl cyclotransferase) were expressed at significantly lower levels in lesional versus nonlesional sites of atopic dermatitis patients with and without history of eczema herpeticum; epidermal fatty acid binding protein was expressed at significantly higher levels in patients with methicillin resistant Staphylococcus aureus. Conclusion This non-invasive, semi-quantitative profiling method has revealed novel proteins likely involved in the pathogenesis of atopic dermatitis. The lower expression of skin barrier proteins and enzymes involved in the generation of the natural moisturizing factor could further exacerbate barrier defects and perpetuate water loss from the skin. The greater expression of epidermal fatty acid binding protein, especially in patients colonized with methicillin-resistant Staphylococcus aureus, may perpetuate the inflammatory response via eicosanoid signaling. PMID:21211653

  3. ATOPIC DERMO-RESPIRATORY SYNDROME IS A CORRELATE OF ECZEMA HERPETICUM

    PubMed Central

    Hinz, T.; Zaccaro, D.; Byron, M.; Brendes, K.; Krieg, T.; Novak, N.; Bieber, T.

    2010-01-01

    Background Factors favouring the emergence of Eczema herpeticum (EH) in patients with atopic dermatitis (AD) remain elusive. The aim of this work was to identify changes in clinical and laboratory parameters in acute EH patients, before and after 6 weeks of treatment, as well as differences between AD patients with and without a history of EH. Methods A total of 235 adult subjects were included and subdivided into 6 groups: (i) AD patients with acute EH, (ii) AD patients with history of EH, (iii) AD without EH but with recurrent HSV infections, (iv) AD without EH or recurrent HSV infections and healthy non-AD controls (v) with and (vi) without recurrent HSV infections. Clinical examination of AD, assessment of atopic status and severity were done. Total IgE, allergen-specific IgE and differential blood count were analysed. Clinical diagnosis of acute EH was confirmed by PCR. Results More male AD patients are affected by EH than females. Acute episodes of EH are characterized by lower levels of lymphocytes and higher levels of monocytes. AD patients with history of EH display higher total IgE serum levels (ADEH+HSV+ vs. ADEH−HSV+, p<0.001) and higher sensitization profiles and stronger severity of AD (EASI and SCORAD; ADEH+HSV+ vs. ADEH−HSV+, p<0.001). Concomitant asthma and rhinitis were identified as correlates of EH. Conclusion From these data we conclude that AD patients with EH display a distinct clinical and biological phenotype. PMID:21255038

  4. Close association of predominant genotype of herpes simplex virus type 1 with eczema herpeticum analyzed using restriction fragment length polymorphism of polymerase chain reaction.

    PubMed

    Yoshida, Masami; Umene, Kenichi

    2003-04-01

    Herpes simplex virus type 1 (HSV-1) strains belonging to the same genotype can possibly share biological properties and clinical manifestations common to the genotype. We classified previously 66 HSV-1 strains into 35 genotypes (F1-F35) using restriction fragment length polymorphism (RFLP) and F1 and F35 genotypes were revealed to be predominant [Arch. Virol. 13 (1993) 29]. It was found later that the F35 genotype seemed to be closely associated with eczema herpeticum [J. Med. Virol. 49 (1996) 329]. In the present study, a convenient method was developed for classification of two predominant genotypes by RFLP of polymerase chain reaction (RFLP-PCR). Using this method, genotypes of 21 strains isolated from eczema herpeticum were analyzed; seven of 21 strains (33.3%) were of F1 and five of 21 (23.8%) were of F35. Genotypes of 19 strains isolated from facial herpes other than eczema herpeticum were as follows; six of 19 (31.6%) strains were of F1 and one of 19 (5.3%) were of F35. Thus, strains belonging to F35 were appear to have been isolated more frequently from eczema herpeticum (5/21) than from facial herpes (1/19). These ratios showed a statistically significant difference. These results support the hypothesis that F35 strains is clearly associated with eczema herpeticum, in agreement with previous study. This is the first report of PCR-based approach for classification of HSV-1 strains into genotypes seeking an association of a genotype with clinical manifestation. PMID:12668262

  5. Eczema

    MedlinePlus

    Eczema is a term for several different types of skin swelling. Eczema is also called dermatitis. Most types cause dry, ... red, and to swell and itch even more. Eczema is not contagious. The cause is not known. ...

  6. Eczema

    MedlinePlus

    ... En Español Making a Change – Your Personal Plan Hot Topics Meningitis Choosing Your Mood Prescription Drug Abuse ... In an eczema flare-up, skin may feel hot and itchy at first. Then, if the person ...

  7. MRSA

    MedlinePlus

    MRSA stands for methicillin-resistant Staphylococcus aureus. It causes a staph infection (pronounced "staff infection") that is resistant to several common antibiotics. There are two types of infection. Hospital- ...

  8. MRSA

    MedlinePlus

    ... Sometimes doctors prescribe antibiotics to treat more stubborn staph infections. MRSA is different from other staph bacteria because ... of the antibiotics doctors usually use to treat staph infections. (Methicillin is a type of antibiotic, which is ...

  9. MRSA

    MedlinePlus

    ... newsletter | contact Share | MRSA A A A Understanding Staph Infections Staphylococcus aureus , commonly known as "staph," is a ... skin and soft tissue infections. This type of staph infection, known as community-acquired, or community-associated, methicillin- ...

  10. Dyshidrotic Eczema

    MedlinePlus

    ... A A As displayed in this image, the blisters of dyshidrotic dermatitis are often difficult to see ... Dyshidrotic eczema manifests as small, itchy, fluid-filled blisters. Its cause is unknown. Dyshidrotic eczema often comes ...

  11. Dyshidrotic eczema

    MedlinePlus

    ... 2014:chap 190. James WD, Berger TG, Elston DM. Atopic dermatitis, eczema, and noninfectious immunodeficiency disorders. In: James WD, Berger TG, Elston DM, eds. Andrews' Diseases of the Skin: Clinical Dermatology . ...

  12. Hand Eczema

    PubMed Central

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

    2014-01-01

    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

  13. Eczema (atopic)

    PubMed Central

    2006-01-01

    Introduction Atopic eczema affects 15-20% of schoolchildren worldwide and 2-10% of adults. Only about 60% of people with eczema demonstrate atopy, with specific immunoglobulin E responses to allergens. Methods and outcomes We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of self-care treatments, topical medical treatments, and dietary interventions in adults and children with established atopic eczema? What are the effects of breast feeding as a primary preventive intervention in predisposed infants? What are the effects of reducing allergens as a primary preventive intervention in predisposed infants? We searched: Medline, Embase, The Cochrane Library and other important databases up to September 2006 (BMJ Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). Results We found 33 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. Conclusions In this systematic review we present information relating to the effectiveness and safety of the following interventions: breast feeding, controlling house dust mites, corticosteroids, dietary exclusion of eggs or cows' milk, elemental diets, emollients, essential fatty oils, few-foods diet, multivitamins, pimecrolimus, probiotics, pyridoxine, reducing maternal dietary allergens, tacrolimus, vitamin E, and zinc supplements.

  14. Photos of MRSA Infections

    MedlinePlus

    ... Methicillin-resistant Staphylococcus aureus (MRSA) Infections Share Compartir Photos of MRSA Infections In the community, most MRSA ... Educational Resources Environmental Cleaning & Disinfecting Athletic Facilities Laundry Photos of MRSA Infections MRSA in Healthcare Settings Patients ...

  15. MRSA Screening

    MedlinePlus

    ... this page helpful? Formal name: Methicillin resistant Staphylococcus aureus Screening Related tests: Wound Culture At a Glance ... How is it used? A methicillin resistant Staphylococcus aureus (MRSA) screen is a test that looks solely ...

  16. Stopping MRSA

    ERIC Educational Resources Information Center

    Vogel, Carl

    2008-01-01

    Last fall, a fever gripped the nation--an overheating of news stories about the so-called super bug: methicillin-resistant Staphylococcus aureus, "staph," or simply "MRSA." The bacteria are not airborne contaminants, but when they enter a person's body through cuts, abrasions, or other breaks in the skin, they can cause infections, which can…

  17. Stopping MRSA

    ERIC Educational Resources Information Center

    Vogel, Carl

    2008-01-01

    Last fall, a fever gripped the nation--an overheating of news stories about the so-called super bug: methicillin-resistant Staphylococcus aureus, "staph," or simply "MRSA." The bacteria are not airborne contaminants, but when they enter a person's body through cuts, abrasions, or other breaks in the skin, they can cause infections, which can

  18. Eczema and Atopic Dermatitis

    MedlinePlus

    ... to anything that can irritate your skin. Wear cotton gloves under plastic gloves to soak up sweat ... make your eczema worse. Wear clothes made of cotton or a cotton blend. Wool and some synthetic ...

  19. Types of Eczema (Dermatitis)

    MedlinePlus

    ... on a patient's palm: The tiny, deep-seated blisters are often very itchy. Dyshidrotic eczema: Overview What ... dry skin. People also develop small, deep-seated blisters, usually on their hands. It’s also possible to ...

  20. Eek! It's Eczema!

    MedlinePlus

    ... Words En Español What Other Kids Are Reading Movie: Digestive System Winter Sports: Sledding, Skiing, Snowboarding, Skating ... some kind of scaly creature from a monster movie. No need to worry. It's just eczema. What ...

  1. Eczema (Atopic Dermatitis) Complications

    MedlinePlus

    ... Asthma Food Allergy Immune System Methicillin-Resistant Staphylococcus Aureus (MRSA) National Library of Medicine, MedlinePlus ​ Javascript Error ... dermatitis. Bacterial Infections Scanning electron micrograph of Staphylococcus aureus bacteria. Credit: NIAID A major health risk associated ...

  2. Hand eczema: an update.

    PubMed

    Lakshmi, Chembolli; Srinivas, C R

    2012-01-01

    Eczema, the commonest disorders afflicting the hands, is also the commonest occupational skin disease (OSD). In the dermatology outpatient departments, only the severe cases are diagnosed since patients rarely report with early hand dermatitis. Mild forms are picked up only during occupational screening. Hand eczema (HE) can evolve into a chronic condition with persistent disease even after avoiding contact with the incriminated allergen / irritant. The important risk factors for hand eczema are atopy (especially the presence of dermatitis), wet work, and contact allergy. The higher prevalence in women as compared to men in most studies is related to environmental factors and is mainly applicable to younger women in their twenties. Preventive measures play a very important role in therapy as they enable the affected individuals to retain their employment and livelihood. This article reviews established preventive and therapeutic options and newer drugs like alitretinoin in hand eczema with a mention on the etiology and morphology. Identifying the etiological factors is of paramount importance as avoiding or minimizing these factors play an important role in treatment. PMID:22960812

  3. MRSA and the Workplace

    MedlinePlus

    ... Are staph and MRSA infections treatable? Yes. Many staph skin infections may be treated by draining the abscess or ... try to drain the infection yourself. However, some staph and MRSA infections are treated with antibiotics. If you are given ...

  4. Understanding the effects of eczema.

    PubMed

    Cosh, Jackie

    2016-03-01

    EMOTIONAL AND practical support is crucial for the families of children with eczema. This was the main feedback from a workshop organised by the charity Eczema Outreach Scotland for first-year nursing students at the University of Edinburgh. PMID:26954633

  5. Does eczema lead to asthma?

    PubMed

    Burgess, John A; Lowe, Adrian J; Matheson, Melanie C; Varigos, George; Abramson, Michael J; Dharmage, Shyamali C

    2009-06-01

    The nature of the relationship between eczema, asthma, and allergic rhinitis has been controversial. It has been commonly held that these disorders, while sharing genetic and environmental risk factors, are unrelated disorders that may develop sequentially along an atopic pathway. Conversely, the link between eczema and these later-onset respiratory disorders may be causal. This review examines the relationship between eczema, asthma, and allergic rhinitis in the context of the atopic march, the skin barrier, and recent developments in eczema genetics; and we propose that the relationship is causal. We describe a plausible biological pathway with eczema as the first step in a progressive atopic march that over time leads to asthma and/or allergic rhinitis. Such a pathway has implications for our understanding of these disorders and steps that might be made to prevent the development of asthma in particular. We propose that intervention studies in eczema should be conducted to confirm or refute this causal relationship. Such studies may materially improve the quality of life of eczema patients and will have important public health benefits if the interventions lead to a reduction in the burden of asthma. PMID:19544160

  6. [Staphylococcus aureus and atopic eczema].

    PubMed

    Neuber, K; Knig, W; Ring, J

    1993-03-01

    The bacterial skin flora of patients with atopic eczema is different from that in healthy normal persons. In addition, such patients more often suffer from microbial infections. Differences in sebum and sweat secretion and increased bacterial adhesion to epithelial cells in atopic eczema may predispose to enhanced amounts of Staphylococcus aureus, for example, on the skin. Defective host-defence mechanisms with dysfunction of cellular and humoral immune reactions have been suggested. On the other hand, bacterial antigens may induce allergic reactions, e.g. increased IgE synthesis and enhanced expression of the low-affinity receptor for IgE (CD23, Fc epsilon RII), and the release of inflammatory mediators such as leukotrienes and histamine. The production of bacterial toxins might be important for the pathophysiology of atopic eczema. This paper summarizes the present data and tries to integrate them into a model for the induction of atopic eczema. PMID:8463093

  7. What is MRSA?

    PubMed

    Pantosti, A; Venditti, M

    2009-11-01

    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

  8. MRSA in Schools

    ERIC Educational Resources Information Center

    US Department of Education, 2007

    2007-01-01

    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…

  9. Eczema Coxsackium” and Unusual Cutaneous Findings in an Enterovirus Outbreak

    PubMed Central

    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

    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. PMID:23776120

  10. MRSA burden and interventions.

    PubMed

    Liebowitz, Lynne D

    2009-08-01

    Infections caused by meticillin-resistant Staphylococcus aureus (MRSA) remain a major problem worldwide. In England, the Department of Health set a target for decreasing MRSA bloodstream infections throughout the country by 50% by 2008, based on the 2003/2004 national figure. To aid hospitals in achieving their individual targets, guidance was provided in the form of care bundles, which were initially related to infection-control practices. Several studies have shown that decreasing the use of fluoroquinolones and/or cephalosporins results in a decrease in MRSA infection rates. In 2007 the Department of Health published guidance on antibiotic prescribing, following which the MRSA bloodstream infection rate dropped more rapidly than in 2006, and the target was met. PMID:19596108

  11. Promoting effective education for children with eczema.

    PubMed

    Thompson, Deryn

    2016-01-27

    Patient and parent education for children with eczema should follow a consistent approach, guided by an established framework that combines aspects of nursing, education and cognitive psychology. Using the framework enables nurses to understand how to use and develop their skills when providing education about the management of eczema in children, and enables patients and parents to understand and develop the skills required to manage a chronic condition such as eczema. This framework is transferable to the adult context. PMID:26967886

  12. Eczema

    MedlinePlus

    ... to scratchy fabrics or chemicals in soaps and detergents should Wear soft fabrics such as 100% cotton ... baths with room temperature water. Use mild laundry detergent with no dyes or perfumes. Skip using fabric ...

  13. Systematic review of treatments for atopic eczema.

    PubMed Central

    Hoare, C; Li Wan Po, A; Williams, H

    2000-01-01

    BACKGROUND: Atopic eczema is the commonest inflammatory skin disease of childhood, affecting 15-20% of children in the UK at any one time. Adults make up about one-third of all community cases. Moderate-to-severe atopic eczema can have a profound effect on the quality of life for both sufferers and their families. In addition to the effects of intractable itching, skin damage, soreness, sleep loss and the social stigma of a visible skin disease, other factors such as frequent visits to doctors, special clothing and¿the need to constantly apply messy topical applications all add to the burden of disease. The cause of atopic eczema is unknown, though a genetic pre-disposition and a combination of allergic and non-allergic factors appear to be important in determining disease expression. Treatment of atopic eczema in the UK is characterised by a profusion of treatments aimed at disease control. The evidential basis of these treatments is often unclear. Most people with atopic eczema are managed in primary care where the least research has been done. OBJECTIVES: The objectives of this scoping review are two-fold. To produce an up-to-date coverage 'map' of randomised controlled trials (RCTs) of treatments of atopic eczema. To assist in making treatment recommendations by summarising the available RCT evidence using qualitative and quantitative methods. METHODS: DATA SOURCES: Data sources included electronic searching of MEDLINE, EMBASE, the Cochrane Controlled Clinical Trials Register, the Cochrane Skin Group specialised register of trials, hand-searching of atopic eczema conference proceedings, follow-up of references in retrieved articles, contact with leading researchers and requests to relevant pharmaceutical companies. INCLUSION/EXCLUSION CRITERIA: Only RCTs of therapeutic agents used in the prevention and treatment of people with atopic eczema of any age were considered for inclusion. Only studies where a physician diagnosed atopic eczema or atopic dermatitis were included. DATA EXTRACTION: Data extraction was conducted by two observers onto abstraction forms, with discrepancies resolved by discussion. QUALITY ASSESSMENT: The quality assessment of retrieved RCTs included an assessment of: a clear description of method and concealment of allocation of randomisation, the degree to which assessors and participants were blinded to the study interventions, and whether all those originally randomised were included in the final main analysis. DATA SYNTHESIS: Where possible, quantitative pooling of similar RCTs was conducted using the Cochrane Collaboration's methods. Where statistical heterogeneity was found, sources of heterogeneity in terms of study participants, formulation or posology of intervention, and use of co-treatments were explored. Where pooling was not deemed to be appropriate, detailed descriptions of the study characteristics and main reported results were presented along with comments on study quality. RESULTS: A total of 1165 possible RCTs were retrieved in hard copy form for further scrutiny. Of these, 893 were excluded from further analysis because of lack of appropriate data. The 272 remaining RCTs of atopic eczema covered at least 47 different interventions, which could be broadly categorised into ten main groups. Quality of reporting was generally poor, and limited statistical pooling was possible only for oral cyclosporin, and only then after considerable data transformation. There was reasonable RCT evidence to support the use of oral cyclosporin, topical corticosteroids, psychological approaches and ultraviolet light therapy. There was insufficient evidence to make recommendations on maternal allergen avoidance for disease prevention, oral antihistamines, Chinese herbs, dietary restriction in established atopic eczema, homeopathy, house dust mite reduction, massage therapy, hypnotherapy, evening primrose oil, emollients, topical coal tar and topical doxepin. (ABSTRACT TRUNCATED) PMID:11134919

  14. General Information about MRSA in the Community

    MedlinePlus

    ... MRSA skin infections first think they have a spider bite. However, unless a spider is actually seen, the irritation is likely not a spider bite. Most staph skin infections, including MRSA, appear ...

  15. MRSA in Croatia: prevalence and management.

    PubMed

    Budimir, Ana

    2016-02-01

    Infections caused by methicillin-resistant Staphylococcus aureus (MRSA) are associated with increased morbidity, mortality and length of hospital stay. MRSA is a major pathogen in hospitals and an important pathogen in community infections with few severe and fatal cases. However, MRSA causes the majority of skin and soft tissue infections in the US. The burden of community MRSA is much smaller in Europe, but there are reports of livestock-associated MRSA (LA-MRSA) isolated from pigs and cattle causing significant infections in the people who are connected to these farms. MRSA has been present in Croatia for more than 45 years, and it exerts a different impact on health-care infections. A remarkable increase in MRSA percentage was noted in primarily sterile samples in 2002 (37%) in comparison to 2001 (31%). This percentage remained quite high until 2008, when the first signs of a reduced trend were observed. The lowest percentage was 22% in 2012. PMID:26559874

  16. Environmental Cleaning and Disinfecting for MRSA

    MedlinePlus

    ... is not absolutely necessary. More about laundry... Top Facility Cleaning & Disinfection after a MRSA Infection When MRSA ... that have been exposed to infections. Top Shared Equipment Shared equipment that comes into direct skin contact ...

  17. Mite elimination--clinical effect on eczema.

    PubMed

    Friedmann, P S; Tan, B B

    1998-01-01

    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

  18. MRSA as a rare cause of vaginitis.

    PubMed

    de Bree, L C J; van Rijen, M M L; Coertjens, H P M; van Wijngaarden, P

    2015-12-01

    We describe a 26-year-old otherwise healthy woman with MRSA vaginitis. Traditional MRSA risk factors were absent and additional screening sites were negative. Patient was treated successfully with oral antibiotics combined with topical lactic acid emulsion. Because her partner appeared to have solitary MRSA carriage on the glans, a suggestion of sexual transmission was made. He was treated successfully with topical mupirocin ointment. Although solitary vaginal MRSA carriage and infection seems to be rare and its clinical impact is yet undefined, clinicians should consider adding the genitourinary tract to traditional screening sites in case of recurrent MRSA infections. PMID:25764306

  19. Preventing MRSA infection in the community.

    PubMed

    Lautenbach, Ebbing; Zaoutis, Theoklis

    2009-08-01

    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

  20. [Systemic contact eczema against Balsam of Peru].

    PubMed

    Pfützner, Wolfgang; Niedermeier, Andrea; Thomas, Peter; Przybilla, Bernhard

    2003-09-01

    Balsam of Peru (PB; Myroxylon pereirae) is a natural product derived from resin of a tropical tree (MyroxyIon balsamum (L.) Harms var. pereirae (Royle) Baillon). Because of its antiseptic and aromatic properties PB or PB-components can be found worldwide not only in many health care and cosmetic products, but also in food items and semiluxury food. PB contains a wide variety of potent contact allergens leading to hypersensitivity reactions not only after topical application but also oral uptake. We report a 51-year-old brewer with chronic eczema of the hands who showed delayed-type patch test reactions against PB and fragrance-mix. Oral PB-challenge led to exacerbation of the eczema 5 and in a repeated test 2 days later. We here review this probably quite often overlooked disease and the therapeutic consequences which require profound knowledge about the wide distribution of PB when advising the patient about a PB-restricted diet. In addition, this unusual case report demonstrates that one has to consider marked delayed hypersensitivity reaction when investigating a systemic contact allergy. PMID:16285279

  1. Vitamin D and the Development of Atopic Eczema

    PubMed Central

    Palmer, Debra J.

    2015-01-01

    A “vitamin D hypothesis” has been proposed to explain the increased prevalence of eczema in regions with higher latitude. This review focuses on the current available evidence with regard to the possible effect of vitamin D on the development of atopic eczema. Observational studies have indicated a link between vitamin D status and eczema outcomes, including lower serum vitamin D levels associated with increased incidence and severity of eczema symptoms. Vitamin D is known to have a regulatory influence on both the immune system and skin barrier function, both critical in the pathogenesis of eczema. However heterogeneous results have been found in studies to date investigating the effect of vitamin D status during pregnancy and infancy on the prevention of eczema outcomes. Well-designed, adequately powered, randomised controlled trials are needed. The study design of any new intervention trials should measure vitamin D levels at multiple time points during the intervention, ultraviolet (UV) radiation exposure via the use of individual UV dosimeters, and investigate the role of individual genetic polymorphisms. In conclusion, the current available evidence does not allow firm conclusions to be made on whether vitamin D status affects the development of atopic eczema. PMID:26239464

  2. MRSA

    MedlinePlus

    ... with the type of antibiotics that usually cure staph infections. When this occurs, the germ is said to ... such as the lungs, heart, or brain. Serious staph infections are more common in people with chronic (long- ...

  3. Swine MRSA isolates form robust biofilms

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Methicillin-resistant Staphylococcus aureus (MRSA) colonization of livestock animals is common and prevalence rates for pigs have been reported to be as high as 49%. Measures to prevent, control, or eliminate MRSA in swine is of considerable public health concern. Bacterial colonization of both biol...

  4. MRSA - Multiple Languages: MedlinePlus

    MedlinePlus

    ... الذهبية المقاومة للمثيسيلين - العربية Bilingual PDF Health Information Translations Bosnian (Bosanski) MRSA (Methicillin Resistant Staphylococcus Aureus) MRSA ( ...

  5. General Information about MRSA in Healthcare Settings

    MedlinePlus

    ... topics, including recently published articles. Is MRSA an Antibiotic Resistance Problem? Yes. Staph bacteria have become resistant to ... MRSA and other types of resistant staph major antibiotic-resistance problems. In CDC’s landmark report, Antibiotic Resistance Threats ...

  6. Swine MRSA isolates form robust biofilms

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Background: Methicillin-resistant Staphylococcus aureus (MRSA) colonization of livestock animals is common and prevalence rates for pigs have been reported to be as high as 49%. Measures to prevent, control, or eliminate MRSA in swine is of considerable public health concern. Bacterial colonization ...

  7. Update on Epidemiology and Treatment of MRSA Infections in Children

    PubMed Central

    David, Michael Z.; Daum, Robert S.

    2013-01-01

    In 2000-10 the epidemiology of pediatric MRSA infections in the United States was transformed with an epidemic of CA-MRSA infections. We review the epidemiology of MRSA in the community and in the health care setting, including intensive care units, among infants and CF patients, and in households as well as the impact that the CA-MRSA epidemic has had on hospitalization with MRSA infections. Risk factors for carriage, transmission, and initial and recurrent infection with MRSA are discussed. New studies on the treatment of pediatric MRSA infections and on the efficacy of MRSA decolonization are reviewed. PMID:24040579

  8. Challenges of identifying eczema in darkly pigmented skin.

    PubMed

    Myers, Joan

    2015-07-01

    There is a paucity of information about the difference in the presentation of eczema in darkly pigmented skin compared to children with fair or white skin. This article describes the possible challenges of diagnosing eczema in children with darkly pigmented skin. The physiological difference in darkly pigmented skin compared with fair or white skin is explored, and how eczema may be manifested and identified in darkly pigmented skin. The author uses the term darkly pigmented skin to describe children of black Caribbean, African or Asian descent. PMID:26156613

  9. Anti-infective drug development for MRSA.

    PubMed

    Daniel, Anu

    2014-01-01

    Staphylococcus aureus is an important pathogen linked to serious infections both in the hospital and the community settings. The challenge to treat infections caused by S. aureus has increased because of the emergence of multidrug-resistant strains such as methicillin-resistant S. aureus (MRSA). A limited spectrum of antibiotics is available to treat MRSA infections. This chapter reviews antimicrobial agents currently in use for the treatment of MRSA infections as well as agents that are in various stages of development. This chapter also reviews the alternate approaches that are being explored for the treatment of staphylococcal infections. PMID:24085703

  10. Laboratory evaluation of the BD MAX MRSA assay.

    PubMed

    Widen, Raymond; Healer, Vicki; Silbert, Suzane

    2014-07-01

    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

  11. Livestock associated MRSA (LA-MRSA) and its relevance for humans in Germany.

    PubMed

    Cuny, Christiane; Köck, Robin; Witte, Wolfgang

    2013-08-01

    Livestock-associated Staphylococcus aureus (LA-MRSA) are mainly associated with the clonal complex (CC) 398. Although having its main reservoir as MRSA in livestock such as pigs, poultry or cattle LA-MRSA CC398 has no pronounced host specificity and can colonize or infect other animals such as horses and dogs and also humans. In German conventional farming systems nasal colonization of the animals and of humans occupationally exposed to them (up to 86%) are frequent. Further human-to-human dissemination in households occurs more rarely in general (∼4% of humans living on farms but without occupational exposition). Nasal colonization with LA-MRSA of humans at hospital admission is found in 0.08-0.2% for Germany in general. However, this proportion is higher in areas with a high density of livestock production such as in northwestern North Rhine-Westphalia or Lower Saxony. LA-MRSA CC398 is not less pathogenic for humans than S. aureus in general. Hence, LA-MRSA accounts for ∼15% of all MRSA isolates from deep-seated skin and soft-tissue infections in the community and for about 0.8-2% of all MRSA isolated from clinical specimens obtained in hospital settings. When introduced into the hospital it can cause postoperative wound infections and even septicemia. Differently from hospital-associated MRSA clones, LA-MRSA CC398 has obviously limited capacity to spread in the nosocomial setting so far (proportion of ∼1.8% among MRSA from nosocomial infections, the proportion among MRSA from blood cultures is ∼1%). PMID:23607972

  12. 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 ...

  13. Therapeutic patient education in atopic eczema.

    PubMed

    Barbarot, S; Stalder, J F

    2014-07-01

    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

  14. MRSA prevention strategies and current guidelines.

    PubMed

    Byrne, F M; Wilcox, M H

    2011-12-01

    We review prevention strategies to minimise the risk of MRSA soft tissue and bone infections, which can be devastating for the patient and costly for the healthcare provider. Department of Health (England) policy is that screening for emergency admissions will be mandatory from 2011, in addition to existent elective admission screening. Rapid screening technology has not been shown to be cost-effective, meaning that there will be a lag time between admission and the patient's MRSA status being known. Thus, standard infection control policies regarding isolation of high-risk patients will remain, with a continuing focus on MRSA decolonisation, aimed at minimising the risks of auto-infection and transmission to other patients. Antimicrobial prescribing policies should be designed to take into account the local burden of resistant organisms, but also minimise unnecessary antibiotic use. There is an increasing realisation that reducing the use of fluoroquinolones and third-generation cephalosporins (which have been associated with increased carriage of MRSA) in patient populations where MRSA is prevalent can be a useful control measure. Prevention of orthopaedic infections clearly involves general operating theatre protocols, such as suitable antiseptic skin preparation, and additional measures including the use of laminar airflow. Antibiotic prophylaxis is adjusted in patients known to have MRSA to include a glycopeptide, and local guidelines may adopt such regimens for all patients due to the burden of MRSA in the local patient population. A future development that may have an effect on practice is the development of a Staphylococcus aureus vaccine, which has been shown to be cost-effective in a computer-modelled evaluation. PMID:22196908

  15. MRSA CC398 in the pig production chain.

    PubMed

    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

    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

  16. [Contact eczema caused by pesticides in East Germany].

    PubMed

    Jung, H D; Hönemann, W; Kloth, C; Lübbe, D; Pambor, M; Quednow, C; Rätz, K H; Rothe, A; Tarnick, M

    1989-01-01

    19 allergic, occupational contact eczemas and 1 irrative contact dermatitis caused by pesticides from 1985-86 in the GDR are described. The 20 casuistic reports are supplemented with data concerning age, sex, exposure time, patch-test results, occupation site and dermatological details. The following pesticides were determined: maneb, zineb, mancozeb, propineb, thiram, demephion, dimethoate, propachlor, metham-Na, benomyl, chloralhydrate with chloralmethylhalbacetal, carbaryl, dinocap captan, phenyl-Hg-acetate and trichlodinitrobenzene. Each individual case adhered to the recommended test concentration for skin tests. Contact eczemas brought about by the pesticides demephion and trichlordinitrobenzene have not yet to be described. Those working in gardening seem to be particularly prone. PMID:2525102

  17. [Methicillin-resistant Staphylococcus aureus (MRSA) infection--significance of MRSA in respiratory tract infection].

    PubMed

    Shigeno, Y; Yamashiro, T; Kusano, N

    1990-09-01

    We have examined background factors in MRSA infection in cases in which S. aureus had been isolated from sputa. The incidence of isolation of S. aureus was high and still increasing in expectorated sputa, and causative organisms in the cases of pneumonia and autopsied lungs. A significant correlation was observed between high incidence of isolation of S. aureus and abuse of third-generation cephems. MRSA isolation rates of inpatients was higher than that of outpatients. Among the inpatients such cases with severe underlying diseases and prolonged admission showed the highest incidence of isolation of MRSA. There seemed to be a correlation between distribution of patients with S. aureus and that of rooms with S. aureus in the air. This suggests nosocomial infection. Although MRSA was frequently isolated from sputa, most cases showed no signs of infection, and this suggested that they had been transient colonization. Such antimicrobial agents as rifampicin, teicoplanin, vancomycin reveal excellent antibacterial activity against MRSA and minocycline, ofloxacin were moderately effective. The physician must be informed of the significance of MRSA, because their understanding of MRSA still remains insufficient. PMID:2232262

  18. LA-MRSA CC398 differ from classical community acquired-MRSA and hospital acquired-MRSA lineages: functional analysis of infection and colonization processes.

    PubMed

    Ballhausen, Britta; Jung, Philipp; Kriegeskorte, André; Makgotlho, Phuti Edward; Ruffing, Ulla; von Müller, Lutz; Köck, Robin; Peters, Georg; Herrmann, Mathias; Ziebuhr, Wilma; Becker, Karsten; Bischoff, Markus

    2014-10-01

    Livestock-associated methicillin-resistant Staphylococcus aureus (LA-MRSA) of the clonal complex (CC) 398 became primarily known as colonizers of livestock animals. In the past few years, they have been increasingly introduced into hospitals with subsequent emergence of human infections. However, the (re-)adaptation to the human host is only incompletely understood. This study aimed to assess virulence properties of LA-MRSA CC398 by functional modeling of infection and colonization processes. A selection of 15 human LA-MRSA CC398 isolates and 11 pig-colonizing isolates were characterized regarding their virulence capacities and compared with human isolates of hospital-acquired (HA)-MRSA (CC5, CC22 and CC45) and community-associated (CA)-MRSA (CC8, CC30 and CC80) clonal lineages. Our investigations demonstrated that LA-MRSA CC398 adhered less efficient to human cells and human/bovine plasma fibronectin than CA-MRSA and HA-MRSA isolates. In contrast, the LA-MRSA CC398 isolates revealed a high cytotoxic potential comparable to certain CA-MRSA. Comparing the most prevalent LA-MRSA CC398 spa types (t011, t034, t108), isolates associated with spa t108 showed an increased adhesive and invasive potential paired with an increased ability to evade phagocytosis. The results underline both the pathogenic potential of LA-MRSA in general and the heterogeneity within the CC398 clade regarding the virulence characteristics of CC398 subpopulations. Assuming an ongoing (re-)adaptation to the human host combined with a huge reservoir of LA-MRSA CC398 in livestock and constant zoonotic transmission, the LA-MRSA CC398 lineage has the potential to pose a serious threat to human health. PMID:25034858

  19. Antimicrobial (Drug) Resistance: Methicillin-Resistant Staphylococcus aureus (MRSA)

    MedlinePlus

    ... Share this: Main Content Area Methicillin-Resistant Staphylococcus aureus (MRSA) During the past four decades, methicillin-resistant Staphylococcus aureus , or MRSA, has evolved from a controllable nuisance ...

  20. Usefulness of Rajka & Langeland Eczema Severity Score in Clinical Practice.

    PubMed

    Gånemo, Agneta; Svensson, Åke; Svedman, Cecilia; Grönberg, Britt-Marie; Johansson, Ann-Charlotte Öhman; Wahlgren, Carl-Fredrik

    2016-04-12

    Simple, validated eczema severity scores are required for the evaluation of interventions. The Rajka & Langeland (R&L) scale is based on 3 domains (extent, course, and intensity); however, its validity is not yet confirmed. The aim of this study was to investigate the quality aspects of the R&L scale in clinical practice. In the first part of the study, experts and consumers judged the content validity of the scale. The second part of the study was performed with 87 children during a 4-month eczema school. Construct validity, internal consistency, sensitivity to change, time consumption and health-related quality of life variables were investigated. The content of the R&L scale was considered valid by 45 panellists. Inter- and intra-observer reliability was very good. Divergent construct validity was adequate, while convergent construct validity and internal consistency were inadequate. The R&L scale was able to define a significant improvement in eczema during the eczema school. The time required for completing the R&L assessment was significantly shorter than for objective Severity Scoring of Atopic Dermatitis (SCORAD). The R&L scale is a simple, fast, valid, reliable and sensitive tool for scoring of atopic dermatitis in everyday clinical practice. PMID:26611655

  1. Immunomodulating effect of laser therapy in patients with microbial eczema

    NASA Astrophysics Data System (ADS)

    Dudchenko, Mycola O.; Denisenko, Olga I.

    1999-11-01

    While examining 90 patients suffering the microbial eczema (ME), we revealed disorders of the immune system in the majority of them (3/4). It was established that the inclusion of percutaneous laser irradiation of the blood in a course of multimodality treatment of patients with ME caused an immunomodulating action which resulted in an improved ME course in these patients.

  2. Livestock-Associated MRSA: The Impact on Humans.

    PubMed

    Cuny, Christiane; Wieler, Lothar H; Witte, Wolfgang

    2015-01-01

    During the past 25 years an increase in the prevalence of methicillin-resistant Staphylococcus aureus (HA-MRSA) was recorded worldwide. Additionally, MRSA infections may occur outside and independent of hospitals, caused by community associated MRSA (CA-MRSA). In Germany, we found that at least 10% of these sporadic infections are due to livestock-associated MRSA (LA-MRSA), which is initially associated with livestock. The majority of these MRSA cases are attributed to clonal complex CC398. LA-MRSA CC398 colonizes the animals asymptomatically in about half of conventional pig farms. For about 77%-86% of humans with occupational exposure to pigs, nasal carriage has been reported; it can be lost when exposure is interrupted. Among family members living at the same farms, only 4%-5% are colonized. Spread beyond this group of people is less frequent. The prevalence of LA-MRSA in livestock seems to be influenced by farm size, farming systems, usage of disinfectants, and in-feed zinc. LA-MRSA CC398 is able to cause the same kind of infections in humans as S. aureus and MRSA in general. It can be introduced to hospitals and cause nosocomial infections such as postoperative surgical site infections, ventilator associated pneumonia, septicemia, and infections after joint replacement. For this reason, screening for MRSA colonization at hospital admittance is recommended for farmers and veterinarians with livestock contacts. Intrahospital dissemination, typical for HA-MRSA in the absence of sufficient hygiene, has only rarely been observed for LA-MRSA to date. The proportion of LA-MRSA among all MRSA from nosocomial infections is about 3% across Germany. In geographical areas with a comparatively high density of conventional farms, LA-MRSA accounts for up to 10% of MRSA from septicemia and 15% of MRSA from wound infections. As known from comparative genome analysis, LA-MRSA has evolved from human-adapted methicillin-susceptible S. aureus, and the jump to livestock was obviously associated with several genetic changes. Reversion of the genetic changes and readaptation to humans bears a potential health risk and requires tight surveillance. Although most LA-MRSA (>80%) is resistant to several antibiotics, there are still sufficient treatment options. PMID:27025639

  3. Livestock-Associated MRSA: The Impact on Humans

    PubMed Central

    Cuny, Christiane; Wieler, Lothar H.; Witte, Wolfgang

    2015-01-01

    During the past 25 years an increase in the prevalence of methicillin-resistant Staphylococcus aureus (HA-MRSA) was recorded worldwide. Additionally, MRSA infections may occur outside and independent of hospitals, caused by community associated MRSA (CA-MRSA). In Germany, we found that at least 10% of these sporadic infections are due to livestock-associated MRSA (LA-MRSA), which is initially associated with livestock. The majority of these MRSA cases are attributed to clonal complex CC398. LA-MRSA CC398 colonizes the animals asymptomatically in about half of conventional pig farms. For about 77%–86% of humans with occupational exposure to pigs, nasal carriage has been reported; it can be lost when exposure is interrupted. Among family members living at the same farms, only 4%–5% are colonized. Spread beyond this group of people is less frequent. The prevalence of LA-MRSA in livestock seems to be influenced by farm size, farming systems, usage of disinfectants, and in-feed zinc. LA-MRSA CC398 is able to cause the same kind of infections in humans as S. aureus and MRSA in general. It can be introduced to hospitals and cause nosocomial infections such as postoperative surgical site infections, ventilator associated pneumonia, septicemia, and infections after joint replacement. For this reason, screening for MRSA colonization at hospital admittance is recommended for farmers and veterinarians with livestock contacts. Intrahospital dissemination, typical for HA-MRSA in the absence of sufficient hygiene, has only rarely been observed for LA-MRSA to date. The proportion of LA-MRSA among all MRSA from nosocomial infections is about 3% across Germany. In geographical areas with a comparatively high density of conventional farms, LA-MRSA accounts for up to 10% of MRSA from septicemia and 15% of MRSA from wound infections. As known from comparative genome analysis, LA-MRSA has evolved from human-adapted methicillin-susceptible S. aureus, and the jump to livestock was obviously associated with several genetic changes. Reversion of the genetic changes and readaptation to humans bears a potential health risk and requires tight surveillance. Although most LA-MRSA (>80%) is resistant to several antibiotics, there are still sufficient treatment options. PMID:27025639

  4. The influence of methicillin-resistant Staphylococcus aureus (MRSA) carriers in a nursery and transmission of MRSA to their households.

    PubMed

    Mitsuda, T; Arai, K; Ibe, M; Imagawa, T; Tomono, N; Yokota, S

    1999-05-01

    We examined two persistent MRSA-carrier nurses in a maternity hospital to elucidate the transmission of methicillin-resistant Staphylococcus aureus (MRSA) from healthcare providers to newborn infants and to the nurses' own families. Genotyping of the MRSA strains was performed by analyzing genomic DNA restriction length polymorphisms from pulsed-field gel electrophoresis (PFGE-RFLPs). The children of these nurses were carrying genotypically identical MRSA strains as their mother. Both MRSA carrier families remained asymptomatic over a two-year follow-up period. Eradication of nasal MRSA carriage from the two nurses resulted in declining MRSA carriage rates among infants in the nursery. Healthcare providers may become transient or persistent MRSA carriers whilst working in hospitals in which MRSA is endemic. They may then become a source of infection for patients as well as their own families. We recommend that healthcare providers should be examined for MRSA if an MRSA epidemic occurs in a hospital. The families of any such carriers should also be examined for MRSA. PMID:10363210

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

    PubMed

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

    2012-09-01

    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

  6. The impact of zoonotic MRSA colonization and infection in Germany.

    PubMed

    Köck, Robin; Ballhausen, Britta; Bischoff, Markus; Cuny, Christiane; Eckmanns, Tim; Fetsch, Alexandra; Harmsen, Dag; Goerge, Tobias; Oberheitmann, Boris; Schwarz, Stefan; Selhorst, Thomas; Tenhagen, Bernd-Alois; Walther, Birgit; Witte, Wolfgang; Ziebuhr, Wilma; Becker, Karsten

    2014-01-01

    Methicillin-resistant Staphylococcus aureus (MRSA) causes colonization and infection both in animals and humans. In Germany, cases of MRSA colonization among humans, w+hich affect 0.5-1.5% of the general population and 1.0-2.5% of patients at hospital admission, are still mostly associated with previous healthcare contact and defined epidemic clonal lineages. However, MRSA is also distributed in livestock production in Germany, mostly without causing infections in the animals. These MRSA predominantly belong to the clonal complex (CC) 398, but also to CC9 and CC97. Zoonotic transmission of MRSA CC398 from livestock to humans occurs predominantly in people with occupational livestock contact. Spread of MRSA CC398 to household members of these persons is also frequently observed, but dissemination in the general population is limited so far However, especially in areas with intensive livestock husbandry, about 20-38% of MRSA CC398 cases among humans cannot be epidemiologically linked to direct livestock contact, indicating other transmission pathways. MRSA CC398 currently causes about 2% of all human MRSA infections (wound infections, pneumonia, sepsis) in Germany, but up to 10% in regions characterized by a high density of livestock-farming. The burden of MRSA in companion animals was demonstrated to range between 3.6-9.4% within wound samples obtained from dogs, cats and horses, respectively. In contrast to livestock and horses, MRSA distributed in pet animals are mostly associated with MRSA clonal lineages that are also prevalent in human healthcare facilities. Overall, zoonotic exchange of MRSA between humans and animals has relevant impact on the epidemiology of MRSA in Germany. PMID:25868166

  7. Alitretinoin for the treatment of severe chronic hand eczema

    PubMed Central

    King, Thomas; McKenna, John; Alexandroff, Anton B

    2014-01-01

    Chronic hand eczema is a common and often debilitating condition. Alitretinoin, a 9-cis-retinoic acid and pan-retinoic acid agonist, is a new and effective systemic treatment for chronic hand eczema, which provides another treatment option. A “clear” or “almost clear” response can be achieved in up to half of patients within a 24-week course of treatment. Even higher rates of remission can be obtained with a longer duration of treatment. Alitretinoin has a favorable overall profile of adverse effects; however, female patients who are at risk of becoming pregnant should follow a strict pregnancy-prevention program due to the teratogenic effects of this drug. PMID:25525339

  8. MRSA Infections in HIV-Infected People Are Associated with Decreased MRSA-Specific Th1 Immunity

    PubMed Central

    Utay, Netanya S.; Roque, Annelys; Timmer, J. Katherina; Morcock, David R.; DeLeage, Claire; Somasunderam, Anoma; Weintrob, Amy C.; Agan, Brian K.; Estes, Jacob D.; Crum-Cianflone, Nancy F.; Douek, Daniel C.

    2016-01-01

    People with HIV infection are at increased risk for community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) skin and soft tissue infections (SSTIs). Lower CD4 T-cell counts, higher peak HIV RNA levels and epidemiological factors may be associated with increased risk but no specific immune defect has been identified. We aimed to determine the immunologic perturbations that predispose HIV-infected people to MRSA SSTIs. Participants with or without HIV infection and with MRSA SSTI, MRSA colonization or negative for MRSA were enrolled. Peripheral blood and skin biopsies from study participants were collected. Flow cytometry, flow cytometry with microscopy, multiplex assays of cell culture supernatants and immunohistochemistry were used to evaluate the nature of the immune defect predisposing HIV-infected people to MRSA infections. We found deficient MRSA-specific IFNγ+ CD4 T-cell responses in HIV-infected people with MRSA SSTIs compared to MRSA-colonized participants and HIV-uninfected participants with MRSA SSTIs. These IFNγ+ CD4 T cells were less polyfunctional in HIV-infected participants with SSTIs compared to those without SSTIs. However, IFNγ responses to cytomegalovirus and Mycobacterium avium antigens and MRSA-specific IL-17 responses by CD4 T cells were intact. Upon stimulation with MRSA, peripheral blood mononuclear cells from HIV-infected participants produced less IL-12 and IL-15, key drivers of IFNγ production. There were no defects in CD8 T-cell responses, monocyte responses, opsonization, or phagocytosis of Staphylococcus aureus. Accumulation of CD3 T cells, CD4 T cells, IL-17+ cells, myeloperoxidase+ neutrophils and macrophage/myeloid cells to the skin lesions were similar between HIV-infected and HIV-uninfected participants based on immunohistochemistry. Together, these results indicate that MRSA-specific IFNγ+ CD4 T-cell responses are essential for the control of initial and recurrent MRSA infections in HIV-infected people. PMID:27093273

  9. MRSA Infections in HIV-Infected People Are Associated with Decreased MRSA-Specific Th1 Immunity.

    PubMed

    Utay, Netanya S; Roque, Annelys; Timmer, J Katherina; Morcock, David R; DeLeage, Claire; Somasunderam, Anoma; Weintrob, Amy C; Agan, Brian K; Estes, Jacob D; Crum-Cianflone, Nancy F; Douek, Daniel C

    2016-04-01

    People with HIV infection are at increased risk for community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) skin and soft tissue infections (SSTIs). Lower CD4 T-cell counts, higher peak HIV RNA levels and epidemiological factors may be associated with increased risk but no specific immune defect has been identified. We aimed to determine the immunologic perturbations that predispose HIV-infected people to MRSA SSTIs. Participants with or without HIV infection and with MRSA SSTI, MRSA colonization or negative for MRSA were enrolled. Peripheral blood and skin biopsies from study participants were collected. Flow cytometry, flow cytometry with microscopy, multiplex assays of cell culture supernatants and immunohistochemistry were used to evaluate the nature of the immune defect predisposing HIV-infected people to MRSA infections. We found deficient MRSA-specific IFNγ+ CD4 T-cell responses in HIV-infected people with MRSA SSTIs compared to MRSA-colonized participants and HIV-uninfected participants with MRSA SSTIs. These IFNγ+ CD4 T cells were less polyfunctional in HIV-infected participants with SSTIs compared to those without SSTIs. However, IFNγ responses to cytomegalovirus and Mycobacterium avium antigens and MRSA-specific IL-17 responses by CD4 T cells were intact. Upon stimulation with MRSA, peripheral blood mononuclear cells from HIV-infected participants produced less IL-12 and IL-15, key drivers of IFNγ production. There were no defects in CD8 T-cell responses, monocyte responses, opsonization, or phagocytosis of Staphylococcus aureus. Accumulation of CD3 T cells, CD4 T cells, IL-17+ cells, myeloperoxidase+ neutrophils and macrophage/myeloid cells to the skin lesions were similar between HIV-infected and HIV-uninfected participants based on immunohistochemistry. Together, these results indicate that MRSA-specific IFNγ+ CD4 T-cell responses are essential for the control of initial and recurrent MRSA infections in HIV-infected people. PMID:27093273

  10. Dietary restriction and supplementation in children with atopic eczema.

    PubMed

    Hon, K L E; Leung, T F; Kam, W Y C; Lam, M C A; Fok, T F; Ng, P C

    2006-03-01

    Issues on empirical dietary restriction or supplementation are important but inadequately studied in children with atopic eczema (AE). The dietary habits of children with AE followed at a paediatric dermatology clinic (n = 179) were compared with those without eczema (n = 78). The mothers of 53% of the patients with or without eczema did not breastfeed their children. Common food items avoided by parents whose children have moderate-to-severe AE included fish or seafood [64% vs. 32% of controls, odds ratio (OR) 3.84, 95% CI 2.12-6.95], beef (42% vs. 17%; OR = 3.57, 95% CI 1.79-7.11), eggs (34% vs. 14%; OR = 3.05, 95% CI 1.46-6.34) and cows' milk (18% vs. 4%; OR = 5.56, 95% CI 1.61-19.12); whereas their avoidance was less frequent in children with noneczematous diseases. The avoidance of these foods were often based on belief, but 66% of all AE patients who had avoided any of the above foods reported previous experience of eczema exacerbation by these items. Patients with moderate-to-severe AE were more likely to have consumed 'bird's nest' soup and traditional Chinese medicines. It is important to evaluate whether the AE patients are genuinely 'allergic' to some of these food items. Management is suboptimal if children with food allergy and severe disease continue to consume the culprit food. Conversely, avoidance of common foods in children without food allergy could result in food faddism or malnutrition. PMID:16487087

  11. Amoxicillin functionalized gold nanoparticles reverts MRSA resistance.

    PubMed

    Kalita, Sanjeeb; Kandimalla, Raghuram; Sharma, Kaustav Kalyan; Kataki, Amal Chandra; Deka, Manab; Kotoky, Jibon

    2016-04-01

    In this study, we have described the biosynthesis of biocompatible gold nanoparticles (GNPs) from aqueous extract of the aerial parts of a pteridophyte, "Adiantum philippense" by microwave irradiation and its surface functionalization with broad spectrum beta lactam antibiotic, amoxicillin (Amox). The functionalization of amoxicillin on GNPs (GNP-Amox) was carried out via electrostatic interaction of protonated amino group and thioether moiety mediated attractive forces. The synthesized GNPs and GNP-Amox were physicochemically characterized. UV-Vis spectroscopy, Zeta potential, XRD, FTIR and SERS (surface enhanced raman spectra) results confirmed the loading of Amox into GNPs. Loading of Amox to GNPs reduce amoxicillin cytotoxicity, whereas GNPs were found to be nontoxic to mouse fibroblast cell line (L929) as evident from MTT and acridine orange/ethidium bromide (AO/EtBr) live/dead cell assays. The GNP-Amox conjugates demonstrated enhanced broad-spectrum bactericidal activity against both Gram-positive and Gram-negative bacteria. Furthermore, in-vitro and in-vivo assays of GNP-Amox revealed potent anti-MRSA activity and improved the survival rate. This indicates the subversion of antibiotic resistance mechanism by overcoming the effect of high levels of β-lactamase produced by methicillin resistant Staphylococcus aureus (MRSA). Taken together, this study demonstrates the positive attributes from GNP-Amox conjugates as a promising antibacterial therapeutic agent against MRSA as well as other pathogens. PMID:26838902

  12. Bath additives for the treatment of childhood eczema (BATHE): protocol for multicentre parallel group randomised trial

    PubMed Central

    Santer, Miriam; Rumsby, Kate; Ridd, Matthew J; Francis, Nick A; Stuart, Beth; Chorozoglou, Maria; Wood, Wendy; Roberts, Amanda; Thomas, Kim S; Williams, Hywel C; Little, Paul

    2015-01-01

    Introduction Bath emollients are widely prescribed for childhood eczema, yet evidence of their benefits over direct application of emollients is lacking. Objectives To determine the clinical and cost-effectiveness of adding bath emollient to the standard management of eczema in children Methods and analysis Design: Pragmatic open 2-armed parallel group randomised controlled trial. Setting: General practitioner (GP) practices in England and Wales. Participants: Children aged over 12 months and less than 12 years with eczema, excluding inactive or very mild eczema (5 or less on Nottingham Eczema Severity Scale). Interventions: Children will be randomised to either bath emollients plus standard eczema care or standard eczema care only. Outcome measures: Primary outcome is long-term eczema severity, measured by the Patient-Oriented Eczema Measure (POEM) repeated weekly for 16 weeks. Secondary outcomes include: number of eczema exacerbations resulting in healthcare consultations over 1 year; eczema severity over 1 year; disease-specific and generic quality of life; medication use and healthcare resource use; cost-effectiveness. Aiming to detect a mean difference between groups of 2.0 (SD 7.0) in weekly POEM scores over 16 weeks (significance 0.05, power 0.9), allowing for 20% loss to follow-up, gives a total sample size of 423 children. We will use repeated measures analysis of covariance, or a mixed model, to analyse weekly POEM scores. We will control for possible confounders, including baseline eczema severity and child's age. Cost-effectiveness analysis will be carried out from a National Health Service (NHS) perspective. Ethics and dissemination This protocol was approved by Newcastle and North Tyneside 1 NRES committee 14/NE/0098. Follow-up will be completed in 2017. Findings will be disseminated to participants and carers, the public, dermatology and primary care journals, guideline developers and decision-makers. Trial registration number ISRCTN84102309. PMID:26525422

  13. Contact Allergens Causing Hand Eczema in Ethnic Kashmiri Population: A Study of 7-years

    PubMed Central

    Majid, Imran

    2016-01-01

    Background: Hand eczema is one of the commonest eczemas encountered in dermatology practice. Contact allergens responsible for causing hand eczema vary from one geographical area of the world to another. Aim: The study tries to identify the commonest allergens causing hand eczema in ethnic Kashmiri population. Material and Methods: A total of 800 patients were patch tested at a sole patch testing facility for the local population over a 7-year period out of which 278 were diagnosed with hand eczema. The morphological type of hand eczema was noted and the patch testing results were analyzed. Past or present relevance of the patch-test result to the clinical diagnosis was also analyzed. Results: Hand eczema was the most common type of eczema patch tested over the 7-year period, constituting 34.75% of the patch-tested population. A positive patch-test result was obtained in 135 patients (48.5%) out of which it was found to be clinically relevant in about 65% cases. Nickel and potassium dichromate were found to be the two commonest allergens causing hand eczema in our population with positive patch test reactions in 45 and 27 patients respectively. Females showed a much higher incidence of hand eczema as well as higher patch test positivity than males (54.1% vs. 38.1%). Conclusions: Hand eczema with a positive patch-test report was found to be much more common in females than males and nickel and potassium dichromate were seen to be the commonest allergens causing hand eczema in ethnic Kashmiri population. PMID:26955125

  14. Towards global consensus on outcome measures for atopic eczema research: results of the HOME II meeting.

    PubMed

    Schmitt, Jochen; Spuls, Phyllis; Boers, Maarten; Thomas, Kim; Chalmers, Joanne; Roekevisch, Evelien; Schram, Mandy; Allsopp, Richard; Aoki, Valeria; Apfelbacher, Christian; Bruijnzeel-Koomen, Carla; Bruin-Weller, Marjolein; Charman, Carolyn; Cohen, Arnon; Dohil, Magdalene; Flohr, Carsten; Furue, Masutaka; Gieler, Uwe; Hooft, Lotty; Humphreys, Rosemary; Ishii, Henrique Akira; Katayama, Ichiro; Kouwenhoven, Willem; Langan, Sinéad; Lewis-Jones, Sue; Merhand, Stephanie; Murota, Hiroyuki; Murrell, Dedee F; Nankervis, Helen; Ohya, Yukihiro; Oranje, Arnold; Otsuka, Hiromi; Paul, Carle; Rosenbluth, Yael; Saeki, Hidehisa; Schuttelaar, Marie-Louise; Stalder, Jean-Francois; Svensson, Ake; Takaoka, Roberto; Wahlgren, Carl-Fredrik; Weidinger, Stephan; Wollenberg, Andreas; Williams, Hywel

    2012-09-01

    The use of nonstandardized and inadequately validated outcome measures in atopic eczema trials is a major obstacle to practising evidence-based dermatology. The Harmonising Outcome Measures for Eczema (HOME) initiative is an international multiprofessional group dedicated to atopic eczema outcomes research. In June 2011, the HOME initiative conducted a consensus study involving 43 individuals from 10 countries, representing different stakeholders (patients, clinicians, methodologists, pharmaceutical industry) to determine core outcome domains for atopic eczema trials, to define quality criteria for atopic eczema outcome measures and to prioritize topics for atopic eczema outcomes research. Delegates were given evidence-based information, followed by structured group discussion and anonymous consensus voting. Consensus was achieved to include clinical signs, symptoms, long-term control of flares and quality of life into the core set of outcome domains for atopic eczema trials. The HOME initiative strongly recommends including and reporting these core outcome domains as primary or secondary endpoints in all future atopic eczema trials. Measures of these core outcome domains need to be valid, sensitive to change and feasible. Prioritized topics of the HOME initiative are the identification/development of the most appropriate instruments for the four core outcome domains. HOME is open to anyone with an interest in atopic eczema outcomes research. PMID:22844983

  15. MRSA: A Challenge to Norwegian Nursing Home Personnel

    PubMed Central

    Thorstad, M.; Sie, I.; Andersen, B. M.

    2011-01-01

    In Norway, methicillin-resistant Staphylococcus aureus (MRSA) is increasing in primary healthcare, associated with imported cases and outbreaks in long-term care. According to Norwegian national guidelines, MRSA-exposed healthcare workers (HCWs) and patients are tested. Carriage of MRSA leads to exclusion from work in healthcare institutions. In this study, 388 staff members in 42 nursing homes in Oslo County responded to questions about personal experience with MRSA and of own attitudes to challenges associated with the control and treatment of MRSA patients. Half (52%) of the nursing staff were concerned of becoming infected with MRSA and the consequences of this would be for own social life, family, economy, and work restriction. The concern was associated with risk factors like old buildings not suitable for modern infection control work, low staffing rate (70% without specific training in healthcare and 32% without formal healthcare education), defective cleaning and decolonization, and lack of formal routines and capacity for isolation of MRSA patients. Since the Norwegian MRSA guideline permits patients with persistent MRSA infections to move freely around in nursing homes, the anxiety of the staff to become infected and excluded from job was real. PMID:21941537

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

    PubMed

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

    2011-08-01

    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

  17. Prenatal Exposure to Butylbenzyl Phthalate and Early Eczema in an Urban Cohort

    PubMed Central

    Whyatt, Robin M.; Perzanowski, Matthew S.; Calafat, Antonia M.; Perera, Frederica P.; Goldstein, Inge F.; Chen, Qixuan; Rundle, Andrew G.; Miller, Rachel L.

    2012-01-01

    Background: Recent cross-sectional studies suggest a link between butylbenzyl phthalate (BBzP) in house dust and childhood eczema. Objectives: We aimed to evaluate whether concentrations of monobenzyl phthalate (MBzP), the main BBzP metabolite in urine, during pregnancy are associated prospectively with eczema in young children, and whether this association varies by the childs sensitization to indoor allergens or serological evidence of any allergies. Methods: MBzP was measured in spot urine samples during the third trimester of pregnancy from 407 African-American and Dominican women residing in New York City in 19992006. Repeated questionnaires asked mothers whether their doctor ever said their child had eczema. Child blood samples at 24, 36, and 60 months of age were analyzed for total, anti-cockroach, dust mite, and mouse IgE. Relative risks (RR) were estimated with multivariable modified Poisson regression. Analyses included a multinomial logistic regression model for early- and late-onset eczema versus no eczema through 60 months of age. Results: MBzP was detected in > 99% of samples (geometric mean = 13.6; interquartile range: 5.731.1 ng/mL). By 24 months, 30% of children developed eczema, with the proportion higher among African Americans (48%) than among Dominicans (21%) (p < 0.001). An interquartile range increase in log MBzP concentration was associated positively with early-onset eczema (RR = 1.52 for eczema by 24 months; 95% confidence interval: 1.21, 1.91, p = 0.0003, n = 113 reporting eczema/376 total sample), adjusting for urine specific gravity, sex, and race/ethnicity. MBzP was not associated with allergic sensitization, nor did seroatopy modify consistently the MBzP and eczema association. Conclusions: Prenatal exposure to BBzP may influence the risk of developing eczema in early childhood. PMID:22732598

  18. Contact allergy in eczema patients in Thammasat University Hospital.

    PubMed

    Disphanurat, Wareeporn

    2010-12-01

    Many patients with eczematous dermatitis need continued care in case of a recurrent or persistent skin condition and potential adverse effect of medications. Allergic contact dermatitis should be considered in the differential diagnosis of eczematous dermatitis especially in a patient whose dermatitis is persistent despite appropriate therapies. Patch testing is an essential investigation in patients with persistent eczematous eruption when contact allergy cannot be ruled out. The purpose of this study was to determine the frequency of contact allergy in patients with eczematous dermatitis in Thammasat University Hospital, Prathumthani, Thailand from June 1, 2008 to June 30, 2009 and to identify a possible relationship between sex, age, occupational differences and type of eczema that is associated with positive patch test reactions. A total of 157 patients were patch tested with 23 standard allergens. One or more positive responses were noted in 70 patients (44.6%). The most common allergen was nickel sulfate (26.8%), followed by cobalt chloride (7.6%), p-phenylenediamine (7.0%), fragrance mix (7.0%). Patients who were initially diagnosed with allergic contact dermatitis had significant correlation with positive patch test results to nickel sulfate, cobalt chloride and phenylenediamine (p = 0.00, p = 0.03, p = 0.02, respectively). Patients who were initially diagnosed with endogenous eczema had significant correlation with positive patch test results to colophony (p = 0.04). Contact allergy to fragrance mix was significantly more frequent in patients who had personal history of atopy (p = 0.04). There was no significant correlation between the frequency of contact allergy and sex, age, location of lesion and patient's occupation. In conclusion, this study demonstrated the prevalence in contact allergy in eczema patients in Thammasat University Hospital and compared the results with other region from Thailand. Further study involving many hospitals in various areas in Thailand is needed to provide more insight into contact allergy in Thailand. PMID:21294394

  19. Therapeutic management of anal eczema: an evidence-based review

    PubMed Central

    Havlickova, B; Weyandt, G H

    2014-01-01

    Aim To conduct a systematic review of treatments for anal eczema (AE). Methods We conducted a Medline search for clinical trial data for the treatment of perianal diseases including AE, including papers not published in the English language. We assessed the study reports using the system recommended by the Oxford Centre for Evidence-based Medicine. No meta-analysis was attempted. Results The evidence base for topical treatments used to treat AE is very poor: there are very few studies and many of those that exist are of poor quality. The best evidence was found for medications that are yet to be licensed for AE. Among products with existing licences for the treatment of eczema, our assessment found some evidence to support the continued use of mild-to-moderate corticosteroids first line in most patients. Discussion Features of the perianal region, and the fact that it is almost always occluded, mean that not all medications recommended in the general treatment guidelines for eczema are appropriate for AE. However, there are no specific treatment guidelines for these patients. This may in part be because of the lack of high-quality evidence-based medicine in this therapy area. Many frequently prescribed medications were developed and licensed many years ago, in an era when clinical trial design was not expected to be as rigorous as it is today. Conclusion This review highlights the need to conduct more high-quality clinical trials in patients with AE in order that specific guidelines for the management of this difficult proctological condition can be prepared. PMID:24898365

  20. Assessing United States Patient and Dermatologist Experiences with Severe Chronic Hand Eczema

    PubMed Central

    Baranowski, Eileen; Zelt, Susan; Reynolds, Maria; Sherrill, Beth

    2015-01-01

    Objective: Patients with severe chronic hand eczema often have persistent symptoms that interfere with daily activities, social functioning, and employment. Many patients are refractory to topical corticosteroids. This survey-based study was performed to characterize treatment experiences, impact on productivity, and quality of life of patients with severe chronic hand eczema; understand dermatologists’ severe chronic hand eczema treatment patterns. Design: A web-based survey in the United States queried pre-identified patients with severe chronic hand eczema regarding symptoms, treatment history, quality of life, work productivity, treatment satisfaction, and healthcare utilization. In a separate survey, dermatologists were asked about treatment patterns and satisfaction with currently available therapies. Results: The most commonly reported symptoms currently experienced by patients (n=163) were dryness/flaking (81%), itchiness (75%), and cracking/tearing of the skin (71%). Over the last three months, 84 percent of patients with severe chronic hand eczema self-reported using topical steroids, and 30 percent used systemic corticosteroids or retinoids. Approximately 30 percent reported impairment while working and productivity loss. Patient quality of life was negatively impacted. Dermatologists (n=125) reported most often treating severe chronic hand eczema with topical corticosteroids (99%), followed by topical immunomodulators (71%) and systemic treatments (70%). Only two percent were very satisfied with currently available products. Conclusion: Patients with severe chronic hand eczema experience symptoms that negatively impact work productivity and quality of life. Few dermatologists are very satisfied with currently available severe chronic hand eczema treatment options. PMID:26705436

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

    PubMed

    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

    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

  2. Adverse effects of topical corticosteroids in paediatric eczema: Australasian consensus statement.

    PubMed

    Mooney, Emma; Rademaker, Marius; Dailey, Rebecca; Daniel, Ben S; Drummond, Catherine; Fischer, Gayle; Foster, Rachael; Grills, Claire; Halbert, Anne; Hill, Sarah; King, Emma; Leins, Elizabeth; Morgan, Vanessa; Phillips, Roderic J; Relic, John; Rodrigues, Michelle; Scardamaglia, Laura; Smith, Saxon; Su, John; Wargon, Orli; Orchard, David

    2015-11-01

    Atopic eczema is a chronic inflammatory disease affecting about 30% of Australian and New Zealand children. Severe eczema costs over AUD 6000/year per child in direct medical, hospital and treatment costs as well as time off work for caregivers and untold distress for the family unit. In addition, it has a negative impact on a child's sleep, education, development and self-esteem. The treatment of atopic eczema is complex and multifaceted but a core component of therapy is to manage the inflammation with topical corticosteroids (TCS). Despite this, TCS are often underutilised by many parents due to corticosteroid phobia and unfounded concerns about their adverse effects. This has led to extended and unnecessary exacerbations of eczema for children. Contrary to popular perceptions, (TCS) use in paediatric eczema does not cause atrophy, hypopigmentation, hypertrichosis, osteoporosis, purpura or telangiectasia when used appropriately as per guidelines. In rare cases, prolonged and excessive use of potent TCS has contributed to striae, short-term hypothalamic-pituitary-adrenal axis alteration and ophthalmological disease. TCS use can also exacerbate periorificial rosacea. TCS are very effective treatments for eczema. When they are used to treat active eczema and stopped once the active inflammation has resolved, adverse effects are minimal. TCS should be the cornerstone treatment of atopic eczema in children. PMID:25752907

  3. Clinical inquiries. Do nonmedicated topicals relieve childhood eczema?

    PubMed

    Yates, Jennifer E; Phifer, Jennifer B; Flake, Donna

    2009-05-01

    Emollients are effective first-line treatment to decrease symptoms of eczema and reduce the need to use steroids in children. Tar preparations work, but compliance may be limited. Gamma-linoleic acid preparations, borage oil, and evening primrose oil show efficacy in small studies. MAS063DP cream (Atopiclair) is effective. Chamomile and bathing in acidic hot spring water may be effective, but these treatments have not been adequately evaluated. Wet wrap dressings may be effective but increase the risk of skin infections. Hamamelis distillate creams and massage with essential oils/aromatherapy are ineffective. PMID:19442393

  4. Evaluation of massage with essential oils on childhood atopic eczema.

    PubMed

    Anderson, C; Lis-Balchin, M; Kirk-Smith, M

    2000-09-01

    Childhood atopic eczema is an increasingly common condition in young children. As well as being irritating to the child, it causes sleepless nights for both the child and the family and leads to difficulties in parental relationships and can have severe effects on employment. A group of eight children, born to professional working mothers were studied to test the hypothesis that massage with essential oils (aromatherapy) used as a complementary therapy in conjunction with normal medical treatment, would help to alleviate the symptoms of childhood atopic eczema. The children were randomly allocated to the massage with essential oils group and both counselled and massaged with a mixture of essential oils by the therapist once a week and the mother every day over a period of 8 weeks. The preferred essential oils, chosen by the mothers for their child, from 36 commonly used aromatherapy oils, were: sweet marjoram, frankinsence, German chamomile, myrrh, thyme, benzoin, spike lavender and Litsea cubeba. A control group of children received the counselling and massage without essential oils. The treatments were evaluated by means of daily day-time irritation scores and night time disturbance scores, determined by the mother before and during the treatment, both over an 8 week period; finally general improvement scores were allocated 2 weeks after the treatment by the therapist, the general practitioner and the mother. The study employed a single case experimental design across subjects, such that there were both a within-subject control and between-subjects control, through the interventions being introduced at different times. The results showed a significant improvement in the eczema in the two groups of children following therapy, but there was no significant difference in improvement shown between the aromatherapy massage and massage only group. Thus there is evidence that tactile contact between mother and child benefits the symptoms of atopic eczema but there is no proof that adding essential oils is more beneficial than massage alone. Further studies on the essential oil massage group showed a deterioration in the eczematous condition after two further 8 week periods of therapy, following a period of rest after the initial period of contact. This may have been due to a decline in the novelty of the treatment, or, it strongly suggests possible allergic contact dermatitis provoked by the essential oils themselves. The results of this study indicate the necessity of prolonged studies with novel plant extracts as short-term beneficial results could be overturned by adverse effects after repeated usage. PMID:10960901

  5. Potential for pet animals to harbor methicillin-resistant Staphylococcus aureus (MRSA) when residing with human MRSA patients

    PubMed Central

    Morris, Daniel O.; Lautenbach, Ebbing; Zaoutis, Theoklis; Leckerman, Kateri; Edelstein, Paul H.; Rankin, Shelley C.

    2011-01-01

    Summary Colonization by methicillin-resistant Staphylococcus aureus (MRSA) may be persistent in people, and is horizontally transmissible. The scientific literature suggests that domestic pets may also participate in cross-transmission of MRSA within households. The objectives of this study were to evaluate the prevalence of and risk factors for MRSA carriage by pets residing in households with an MRSA-infected person. From 66 households in which an MRSA infected patient resided, we screened 47 dogs and 52 cats using a swab protocol. Isolates from pets and humans were genotyped using two techniques, and compared for concordance. Human participants completed a 22-question survey of demographic and epidemiologic data relevant to staphylococcal transmission. Eleven of 99 pets (11.5%) representing 9 (13.6%) of households were MRSA-positive, but in only 6 of these households were the human and animal-source strains genetically concordant. Human infection by strain USA 100 was significantly associated with pet carriage [OR = 11.4 (95% C.I. 1.7, 76.9); p=0.013]. Yet, for each day of delay in sampling the pet after the person’s MRSA diagnosis, the odds of isolating any type of MRSA from the pet decreased by 13.9% [(95% C.I. 2.6%, 23.8%); p=0.017)]. It may be concluded that pets can harbor pandemic strains of MRSA while residing in a household with an infected person. However, the source of MRSA to the pet cannot always be attributed to the human patient. Moreover, the rapid attrition of the odds of obtaining a positive culture from pets over time suggests that MRSA carriage may be fleeting. PMID:22233337

  6. Engineering MRSA antimicrobials that are refractory to resistance development

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Methicillin resistant Staphylococcus aureus (MRSA) is one of the most costly multi-drug resistant pathogens to both human animal health, with billions of dollars are spent annually to treat human infections. MRSA is also appearing in livestock (bovine, porcine, poultry) as well as companion animal...

  7. Case 5: non-healing traumatic wound colonised with MRSA.

    PubMed

    Simon, Deborah

    2016-03-01

    A traumatic wound colonised with MRSA failed to respond to topical antimicrobial dressings. Following the combined use of octenilin Wound Gel and octenilin Wound Irrigation Solution, the MRSA was removed in 4 weeks, the necrotic tissue was debrided and the wound started healing. PMID:26949849

  8. DOES THE NOSE KNOW? AN UPDATE ON MRSA DECOLONIZATION STRATEGIES

    PubMed Central

    Abad, C.L.; Pulia, M. S.; Safdar, N.

    2014-01-01

    Colonization with methicillin-resistant Staphylococcus aureus (MRSA) is an important step in the pathogenesis of active infection and is a key factor in the epidemiology of MRSA infection. Decolonization of patients found to have MRSA carriage may be of value in certain patient populations, especially those undergoing elective surgery. However, the most commonly used agent for decolonization, mupirocin, comes with a considerable risk of resistance if widely employed. Recent studies of other novel agents for decolonization show promise but further research is necessary. This review focuses on the pathogenesis from MRSA colonization to infection, identifies the risk factors for colonization, and summarizes decolonization strategies, including novel approaches that may ave a role in decreasing MRSA disease burden. PMID:24150839

  9. New Approaches to Drug Discovery for Combating MRSA.

    PubMed

    Tomoda, Hiroshi

    2016-01-01

    Methicillin-resistant Staphylococuss aureus (MRSA) is a major nosocomial pathogen that has developed resistance to many antibiotics. New anti-infective drugs to prevent and treat MRSA infection are required. Four assay systems were conducted to screen microbial cultures for new anti-infective compounds active against MRSA. Nosokomycins, new members of the phosphoglycolipid family, were discovered from a culture of Streptomyces cyslabdanicus K04-0144 in an MRSA-silkworm infection assay. The target molecule of nosokomycins was suggested to be the transglycosylase of penicillin binding protein (PBP) involved in MRSA peptidoglycan biosynthesis. Spirohexaline, with a hexacycline structure, was isolated from a fungal culture of Penicillium brasilianum FKI-3368 in an enzyme assay of undecaprenyl pyrophosphate (UPP) synthase, which is needed for the synthesis and transport of GlcNAc-MurNAc-pentapeptides from the cytoplasmic membrane site to the external membrane site for peptidoglycan synthesis. Spirohexaline inhibited MRSA growth by the blockade of UPP synthase activity. Cyslabdan, with a cysteine-carrying labdan skeleton, was also discovered from the nosokomycin-producing actinomycete as a potentiator of imipenem activity against MRSA. The molecular target of cyslabdan was identified as FemA, which is involved in the synthesis of a pentaglycine interpeptide bridge in MRSA peptidoglycan. Citridone A with a unique 6-6/5/5-ring system containing a rare phenyl-R-furopyridone skeleton, originally isolated as a potentiator of antifungal miconazole activity, was found to inhibit MRSA yellow pigment production. These new microbial products will serve as lead compounds for developing new anti-infective drugs for combating MRSA. PMID:26833438

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

    PubMed

    Koçak Tufan, Zeliha; Irmak, Hasan; Bulut, Cemal; Cesur, Salih; Kınıklı, Sami; Demiröz, Ali Pekcan

    2012-04-01

    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

  11. Comparison of Methicillin Resistant Staphylococcus Aureus in Healthy Community Hospital Visitors [CA-MRSA] and Hospital Staff [HA-MRSA

    PubMed Central

    Pathare, Nirmal A; Tejani, Sara; Asogan, Harshini; Al Mahruqi, Gaitha; Al Fakhri, Salma; Zafarulla, Roshna; Pathare, Anil V.

    2015-01-01

    Background The prevalence of community-associated methicillin-resistant Staphylococcus aureus [CA-MRSA] is unknown in Oman. Methods Nasal and cell phones swabs were collected from hospital visitors and health-care workers on sterile polyester swabs and directly inoculated onto a mannitol salt agar containing oxacillin, allowing growth of methicillin-resistant microorganisms. Antibiotic susceptibility tests were performed using Kirby Bauer’s disc diffusion method on the isolates. Minimum inhibitory concentration (MIC) was determined for vancomycin and teicoplanin against the resistant isolates of MRSA by the Epsilometer [E] test. A brief survey questionnaire was requested be filled to ascertain the exposure to known risk factors for CA-MRSA carriage. Results Overall, nasal colonization with CA-MRSA was seen in 34 individuals (18%, 95% confidence interval [CI] =12.5%–23.5%), whereas, CA-MRSA was additionally isolated from the cell phone surface in 12 participants (6.3%, 95% CI =5.6%–6.98%). Nasal colonization prevalence with hospital-acquired [HA] MRSA was seen in 16 individuals (13.8%, 95% confidence interval [CI] =7.5%–20.06%), whereas, HA-MRSA was additionally isolated from the cell phone surface in 3 participants (2.6%, 95% CI =1.7–4.54). Antibiotic sensitivity was 100% to linezolid and rifampicin in the CA-MRSA isolates. Antibiotic resistance to vancomycin and clindamycin varied between 9–11 % in the CA-MRSA isolates. Mean MIC for vancomycin amongst CA- and HA-MRSA were 6.3 and 9.3 μg/ml, whereas for teicoplanin they were 13 and 14 μg/ml respectively by the E-test. There was no statistically significant correlation between CA-MRSA nasal carriage and the risk factors (P>0.05, Chi-square test). Conclusions The prevalence of CA-MRSA in the healthy community hospital visitors was 18 % (95% CI, 12.5% to 23.5%) as compared to 13.8% HA-MRSA in the hospital health-care staff. Despite a significant prevalence of CA-MRSA, these strains were mostly sensitive. Recommendation: The universal techniques of hand washing, personal hygiene and sanitation are thus warranted. PMID:26543522

  12. Can EDTA Change MRSA into MSSA? A Future Prospective!

    PubMed Central

    Jain, Sonia; Sarkar, Soma; Ghosh, Sougata; (Mitra), Anita Nandi; Sinha, Anuradha; Chakravorty, Sriparna

    2016-01-01

    Introduction In the present era we are left behind with limited options for the treatment of serious infections caused by multidrug resistant S.aureus, most remarkably nosocomially acquired Methicillin resistant S.aureus (MRSA). The problem increases more when these strains easily become multidrug resistant (MDR) due to biofilm formation. Those staphylococcal species that are vancomycin and linezolid resistant are also resistant to other antistaphylococcal agents which call for an urgent intervention to develop newer antimicrobial agents. Aim The present study was undertaken with the aim to evaluate the antibiofilm effect of EDTA against the biofilm forming MRSA isolates, isolated from different clinical infections. Materials and Methods The biofilms formed on polystyrene microtitre plates by the MRSA strains were treated by different concentrations of EDTA to find out its anti-biofilm activity. Further simultaneously the antibiotic susceptibility pattern was noted down to check whether the MRSA strains become MSSA (Methicillin sensitive S.aureus). Results Our data demonstrates that EDTA at 4mM concentration inhibits biofilm of MRSA and at 20 mM have an ability to reduce and dissociate the biofilm membrane, allowing the antibiotics to enter and convert MRSA strains into MSSA. Conclusion These findings suggest that commercially available EDTA could be used in future to control MRSA and its biofilm- related infections. PMID:27042464

  13. Outcome of MRSA carriers in neurological early rehabilitation

    PubMed Central

    2014-01-01

    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 < 0.001), worse functional status on admission (Barthel index (BI) 13.6 (9.9) vs. 25.6 (24.1), p < 0.001), worse Glasgow Coma Scale (9.5 (3.2) vs. 12.0 (3.3), p < 0.001), more co-diagnoses (20.5 (5.1) vs. 13.3 (5.5), p < 0.001), and higher Patient Clinical Complexity Levels (PCCL). The outcome was significantly worse among MRSA positive patients (BI 25.5 (21.2) vs. 47.4 (31.0), p < 0.001; Early Rehabilitation Index −47.3 (51.4) vs. -26.0 (35.4), p < 0.001). Isolated patients had slightly less therapy per day (131.6 (16.6) vs. 140.2 (18.7) min/day, p < 0.001), but the overall sum of therapy was significantly larger in the 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. PMID:24555811

  14. Hand Sanitizers Carry Unproven Claims to Prevent MRSA Infections

    MedlinePlus

    ... and Drug Administration (FDA). MRSA (methicillin-resistant Staphylococcus aureus ) is a bacterium that can cause severe—even ... to standard treatment with the antibiotic methicillin. " Staphylococcus aureus itself is a very aggressive organism," says Edward ...

  15. Patients and Loved Ones: Information about MRSA in Healthcare Settings

    MedlinePlus

    ... infections, pneumonia, or infections of the blood. When staph infections go untreated, they can lead to serious problems ... the antibiotics that are often used to cure staph infections. Who is Most Likely to Get an MRSA ...

  16. An overview of livestock-associated MRSA in agriculture.

    PubMed

    Harper, Abby L; Ferguson, Dwight D; Leedom Larson, Kerry R; Hanson, Blake M; Male, Michael J; Donham, Kelley J; Smith, Tara C

    2010-04-01

    Researchers, veterinary and health care practitioners, and agricultural producers gathered in Johnston, Iowa, to attend the eighth annual Midwest Rural Agricultural Safety and Health Forum (MRASH), November 2009. Among several focus areas, four plenary talks were given on the current research being conducted examining methicillin-resistant Staphylococcus aureus (MRSA) on swine farms in the United States. These focused on prevalence of MRSA on farms, both in swine and in human workers; the presence of MRSA in air samples and in swine barn shower facilities; and the presence of methicillin-resistant and methicillin-sensitive S. aureus in retail meats. These findings begin to elucidate the overall picture of livestock-associated MRSA in the Midwestern United States. PMID:20407991

  17. Dermoscopy in differential diagnosis of palmar psoriasis and chronic hand eczema.

    PubMed

    Errichetti, Enzo; Stinco, Giuseppe

    2016-04-01

    Clinical differentiation between palmar psoriasis and chronic hand eczema may sometimes be a diagnostic challenge; in such cases histopathological analysis helps to differentiate the two conditions. In the present study, palmar psoriasis and chronic hand eczema were investigated using dermoscopy and the significance of specific dermoscopic features was assessed in order to improve their non-invasive differentiation. Ten patients with biopsy-proven palmar psoriasis and 11 patients with biopsy-proven chronic hand eczema were included in the study. We found that the presence of diffuse white scales was significant in palmar psoriasis whereas the presence of yellowish scales, brownish-orange dots/globules and yellowish-orange crusts was significant in chronic hand eczema. PMID:26460228

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

    PubMed Central

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

    2010-01-01

    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. PMID:20739029

  19. Occupational exposure to laboratory animals causing a severe exacerbation of atopic eczema.

    PubMed

    Bhabha, Friyana K; Nixon, Rosemary

    2012-05-01

    A 24-year-old man with a long history of severe atopic eczema presented with a marked exacerbation requiring hospital admission. It emerged that his occupation as an animal house technician required him to work closely with laboratory animals, particularly mice and rats. Radioallergosorbent tests to mice allergens were markedly elevated. Avoidance of animal work, in conjunction with medical treatment, resulted in a marked improvement of his eczema. PMID:22571570

  20. Knowledge, instruction and behavioural change: building a framework for effective eczema education in clinical practice

    PubMed Central

    Thompson, Deryn Lee; Thompson, Murray John

    2014-01-01

    Aims A discussion on the reasons educational interventions about eczema, by nurses, are successful, with the subsequent development of a theoretical framework to guide nurses to become effective patient educators. Background Effective child and parent education is the key to successful self-management of eczema. When diagnosed, children and parents should learn to understand the condition through clear explanations, seeing treatment demonstrations and have ongoing support to learn practical skills to control eczema. Dermatology nurses provide these services, but no one has proposed a framework of the concepts underpinning their successful eczema educational interventions. Design A discussion paper. Data Sources A literature search of online databases was undertaken utilizing terms ‘eczema OR atopic dermatitis’, ‘education’, ‘parent’, ‘nurs*’, ‘framework’, ‘knowledge’, motivation’, in Scopus, CINAHL, Web of Science, Medline and Pubmed. Limits were English language and 2003–2013. Implications for Nursing The framework can inform discussion on child and parent education, provide a scaffold for future research and guide non-specialist nurses, internationally, in providing consistent patient education about eczema. Conclusion Founded on an understanding of knowledge, the framework utilizes essential elements of cognitive psychology and social cognitive theory leading to successful self-management of eczema. This framework may prove useful as a basis for future research in child and parent education, globally, in the healthcare community. A framework has been created to help nurses understand the essential elements of the learning processes at the foundation of effective child and parent education. The framework serves to explain the improved outcomes reported in previous nurse-led eczema educational interventions. PMID:25312442

  1. A prospective study of the development of hand eczema in an automobile manufacturing industry.

    PubMed

    Kristensen, O

    1992-05-01

    We have not been able to find any prospective study of the risk of developing occupational dermatitis in the car manufacturing industry. To try to define individual predictive risk factors for the development of hand eczema and to determine the prevalence of hand eczema within 1 year in an automobile manufacturing industry, we investigated prospectively 1564 new employees during one year of employment. Only persons with previous atopic dermatitis or hand eczema were restricted to dry and clean workplaces. The employees were personally interviewed and examined before their employment. Written questionnaires were used at 3 and 12 months to obtain information on type of work, exposure, protection and hand dermatitis. All patients developing hand eczema were examined, patch tested and followed to determine the course and consequence of their eczema. The risk turned out to be only 4% on average, but significantly higher in females (6%). Certain sections within the factory such as wet work (canteen/kitchen and cleaning) and work in the paint shop with high exposure to organic solvents carried significantly higher risks. Heavy exposure to mineral oil, a known risk factor, was effectively counteracted by the extensive use of protective gloves to yield a lower than average prevalence in the press and body shop. Individual risk factors for the development of hand eczema were previous hand eczema, atopic dermatitis, but also wool intolerance and hay fever as isolated phenomena. Most cases of hand eczema were mild, of irritant contact type and only 1 employee developed an allergic contact dermatitis due to the working environment.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:1395598

  2. MRSA carriage in healthcare personnel in contact with farm animals.

    PubMed

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

    2008-10-01

    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 pigs and veal calves or other livestock is a risk factor for MRSA carriage in Dutch healthcare workers (HCWs). HCWs at four general hospitals and one university hospital were asked to fill in questionnaires covering contact with animals and to take MRSA cultures of their throat and nares. Cultures of HCWs in contact with livestock were processed with samples from HCWs with no contact with livestock as controls. Seventy-seven of 1721 HCWs (4.4%) reported direct or indirect contact with pigs and/or veal calves and 145 reported contact with other livestock animals. The MRSA carriage rate in the group in contact with pigs and veal calves was 1.7% and in the control group was 0.15%. No carriers were found among HCWs in contact with other livestock. An estimated 3% of hospital staff working in Dutch hospitals serving rural populations belong to a high risk group for MRSA carriage according to the Dutch guidelines. Although MRSA carriage in HCWs in contact with livestock is 10-fold higher than in other HCWs, the difference is not statistically significant. PMID:18701191

  3. In vitro anti-MRSA activity of carvone with gentamicin.

    PubMed

    Mun, Su-Hyun; Kang, Ok-Hwa; Joung, Dae-Ki; Kim, Sung-Bae; Choi, Jang-Gi; Shin, Dong-Won; Kwon, Dong-Yeul

    2014-04-01

    Carvone is one of the naturally occurring monoterpenes, the largest class of secondary metabolites in plants, and exists in two enantiomers, R-carvone (R-car) and S-car. The objective of this study was to investigate the antimicrobial activity of R-car and S-car with gentamicin (GET) against methicillin-resistant Staphylococcus aureus (MRSA). MRSA is a major human pathogen that causes serious problems, including hospital-acquired pneumonia, abscesses and surgical wound infections. Nosocomial MRSA infections often exhibit multidrug resistance. In the present study, antimicrobial susceptibility testing was performed with R-car, S-car and GET using the broth microdilution method. Minimal inhibitory concentration values for R- and S-car against six different strains of S. aureus ranged between 500 and 1,000 μg/ml. Anti-MRSA activity was evaluated using the checkerboard and time-kill assays to investigate the potential synergistic effects of different combinations of the carvone enantiomers and GET. R-car plus S-car, R-car plus GET and S-car plus GET exhibited significant synergistic activity against MRSA. These findings suggest that the single-agent anti-MRSA activities of R-car, S-car and GET are effectively increased through combination therapy. This study showed that carvone may be a potential adjuvant antimicrobial agent. PMID:24669246

  4. Mild eczema affects self-perceived health among pre-adolescent girls.

    PubMed

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

    2014-05-01

    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

  5. Serum concentrations of metalloproteinase 2, metalloproteinase 9 and granzyme B in contact eczema patients

    PubMed Central

    Żbikowska-Gotz, Magdalena; Czajkowski, Rafał; Bartuzi, Zbigniew

    2013-01-01

    Introduction Contact eczema is a common skin condition with complex etiology, variable clinical presentation and lengthy therapy duration. The mechanism of contact eczema is complex, since it is affected by multiple inflammatory mediators. Aim To assess concentrations of metalloproteinase 2 (MMP-2), metalloproteinase 9 (MMP-9) and granzyme B (GzmB) in patients with contact eczema. Material and methods Seventy patients with contact eczema and 30 healthy persons as controls were included in the study. In all subjects, MMP-2, MMP-9 and GzmB were determined using ELISA immunoassay. In study group patients, concentrations were assayed in periods of disease exacerbation and remission. Obtained results were analyzed statistically. Results Mean MMP-2 and GzmB concentrations were found to be significantly higher in the study group than in the control group. Mean MMP-2, MMP-9 and GzmB levels were also statistically significantly higher during skin lesion relapse compared to contact eczema remission periods. Conclusions The presented paper demonstrates that MMP-2, MMP-9 and GzmB are good markers of contact eczema exacerbations. PMID:24278051

  6. Nummular Eczema of Breast: A Potential Dermatologic Complication after Mastectomy and Subsequent Breast Reconstruction

    PubMed Central

    Iwahira, Yoshiko; Nagasao, Tomohisa; Shimizu, Yusuke; Kuwata, Kumiko; Tanaka, Yoshio

    2015-01-01

    Purposes. The present paper reports clinical cases where nummular eczema developed during the course of breast reconstruction by means of implantation and evaluates the occurrence patterns and ratios of this complication. Methods. 1662 patients undergoing breast reconstruction were reviewed. Patients who developed nummular eczema during the treatment were selected, and a survey was conducted on these patients regarding three items: (1) the stage of the treatment at which nummular eczema developed; (2) time required for the lesion to heal; (3) location of the lesion on the reconstructed breast(s). Furthermore, histopathological examination was conducted to elucidate the etiology of the lesion. Results. 48 patients (2.89%) developed nummular eczema. The timing of onset varied among these patients, with lesions developing after the placement of tissue expanders for 22 patients (45.8%); after the tissue expanders were replaced with silicone implants for 12 patients (25%); and after nipple-areola complex reconstruction for 14 patients (29.2%). Nummular eczema developed both in periwound regions (20 cases: 41.7%) and in nonperiwound regions (32 cases: 66.7%). Histopathological examination showed epidermal acanthosis, psoriasiform patterns, and reduction of sebaceous glands. Conclusions. Surgeons should recognize that nummular eczema is a potential complication of breast reconstruction with tissue expanders and silicone implants. PMID:26380109

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

    PubMed Central

    2014-01-01

    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. PMID:24649812

  8. Characterization of methicillin resistant Staphylococcus aureus (MRSA) isolated at the Policlinico Hospital of Bari (Italy).

    PubMed

    Corrente, Marialaura; Monno, Rosa; Totaro, Marta; Martella, Vito; Buonavoglia, Domenico; Rizzo, Caterina; Ricci, Dominga; Rizzo, Giovanni; Buonavoglia, Canio

    2005-01-01

    Methicillin resistant Staphylococcus aureus (MRSA) is an emerging problem. We studied 71 MRSA strains for the presence of mecA gene by PCR, for the enterotoxins production and susceptibility to antimicrobials. In addition, the suitability of Random Amplified Polymorphic DNA analysis (RAPD) and Hypervariable Region (HVR)--PCR as molecular tools for typing MRSA was also tested. All the 71 strains previously found MRSA with conventional methods, presented the gene mec A. By molecular typing five distinct amplicons were found. MRSA with two DRUS were the most common type. RAPD analysis clustered MRSA in 8 groups, three of which were the most common. 26.8% of MRSA produce enterotoxins with a prevalence of type A. MRSA exhibited resistance to all quinolones tested and to gentamycin. Our data suggest that a typing method based on RAPD combined with HVR-PCR may be useful to compare MRSA isolated in a hospital environment, whereas PFGE may be used for further analysis. PMID:15782627

  9. Tea and Coffee Consumption and MRSA Nasal Carriage

    PubMed Central

    Matheson, Eric M.; Mainous, Arch G.; Everett, Charles J.; King, Dana E.

    2011-01-01

    PURPOSE Hot tea and coffee have been found to have antimicrobial properties. The purpose of this study was to determine whether the consumption of tea, coffee, or both is associated with less frequent nasal carriage of methicillin-resistant Staphylococcus aureus (MRSA). METHODS We performed a secondary analysis of data from the 2003–2004 National Health and Nutrition Examination Survey to investigate the relationship between the consumption of coffee, hot tea, cold tea, and soft drinks, and MRSA nasal carriage among the noninstitutionalized population of the United States. RESULTS An estimated 2.5 million persons (1.4% of the population) were MRSA nasal carriers. In an adjusted logistic regression analysis controlling for age, race, sex, poverty-income ratio, current health status, hospitalization in the past 12 months, and use of antibiotics in the past month, individuals who reported consuming hot tea were one-half as likely to have MRSA nasal carriage relative to individuals who drank no hot tea (odds ratio = 0.47; 95% confidence interval, 0.31–0.71). Similarly, individuals who reported consuming coffee had about a one-half reduction in the risk of MRSA nasal carriage relative to individuals who drank no coffee (odds ratio = 0.47; 95% confidence interval, 0.24–0.93). CONCLUSIONS Consumption of hot tea or coffee is associated with a lower likelihood of MRSA nasal carriage. Our findings raise the possibility of a promising new method to decrease MRSA nasal carriage that is safe, inexpensive, and easily accessible. PMID:21747100

  10. A Comprehensive Review of the Treatment of Atopic Eczema.

    PubMed

    Lee, Ji Hyun; Son, Sag Wook; Cho, Sang Hyun

    2016-05-01

    Atopic eczema (AE) is a chronic, inflammatory skin disorder which usually develops in early childhood. In spite of intensive investigations, the causes of AE remain unclear, but are likely to be multifactorial in nature. Environmental factors or genetic-environmental interactions seem to play a key role in disease progression. Among various measures of AE managment, cutaneous hydration, which improves barrier function and relieve itchiness, may be helpful to reduce the need for topical steroid use and therefore should be used as a basic treatment. Avoiding aggravating factors is also a basic treatment of AE. Standard medical treatment with a pharmacologic approach may be necessary if basic treatment fails to control symptoms satisfactorily. Recently, more attention is given to a proactive therapeutic by regular intermittent application of low potency steroids or topical calcineurin inhibitors to prevent new flares. Furthermore, various targeted biologics are being introduced for AE control and are proposed as promising therapies. This paper provides a summary of the recent literature on the manangement of AE and a treatment guideline. PMID:26922927

  11. Microbiota in healthy skin and in atopic eczema.

    PubMed

    Baviera, Giuseppe; Leoni, Maria Chiara; Capra, Lucetta; Cipriani, Francesca; Longo, Giorgio; Maiello, Nunzia; Ricci, Giampaolo; Galli, Elena

    2014-01-01

    The Italian interest group (IG) on atopic eczema and urticaria is member of the Italian Society of Allergology and Immunology. The aim of our IG is to provide a platform for scientists, clinicians, and experts. In this review we discuss the role of skin microbiota not only in healthy skin but also in skin suffering from atopic dermatitis (AD). A Medline and Embase search was conducted for studies evaluating the role of skin microbiota. We examine microbiota composition and its development within days after birth; we describe the role of specific groups of microorganisms that colonize distinct anatomical niches and the biology and clinical relevance of antimicrobial peptides expressed in the skin. Specific AD disease states are characterized by concurrent and anticorrelated shifts in microbial diversity and proportion of Staphylococcus. These organisms may protect the host, defining them not as simple symbiotic microbes but rather as mutualistic microbes. These findings reveal links between microbial communities and inflammatory diseases such as AD and provide novel insights into global shifts of bacteria relevant to disease progression and treatment. This review also highlights recent observations on the importance of innate immune systems and the relationship with normal skin microflora for the maintenance of healthy skin. PMID:25126558

  12. Microbiota in Healthy Skin and in Atopic Eczema

    PubMed Central

    Capra, Lucetta; Longo, Giorgio; Ricci, Giampaolo

    2014-01-01

    The Italian interest group (IG) on atopic eczema and urticaria is member of the Italian Society of Allergology and Immunology. The aim of our IG is to provide a platform for scientists, clinicians, and experts. In this review we discuss the role of skin microbiota not only in healthy skin but also in skin suffering from atopic dermatitis (AD). A Medline and Embase search was conducted for studies evaluating the role of skin microbiota. We examine microbiota composition and its development within days after birth; we describe the role of specific groups of microorganisms that colonize distinct anatomical niches and the biology and clinical relevance of antimicrobial peptides expressed in the skin. Specific AD disease states are characterized by concurrent and anticorrelated shifts in microbial diversity and proportion of Staphylococcus. These organisms may protect the host, defining them not as simple symbiotic microbes but rather as mutualistic microbes. These findings reveal links between microbial communities and inflammatory diseases such as AD and provide novel insights into global shifts of bacteria relevant to disease progression and treatment. This review also highlights recent observations on the importance of innate immune systems and the relationship with normal skin microflora for the maintenance of healthy skin. PMID:25126558

  13. A Comprehensive Review of the Treatment of Atopic Eczema

    PubMed Central

    Lee, Ji Hyun

    2016-01-01

    Atopic eczema (AE) is a chronic, inflammatory skin disorder which usually develops in early childhood. In spite of intensive investigations, the causes of AE remain unclear, but are likely to be multifactorial in nature. Environmental factors or genetic-environmental interactions seem to play a key role in disease progression. Among various measures of AE managment, cutaneous hydration, which improves barrier function and relieve itchiness, may be helpful to reduce the need for topical steroid use and therefore should be used as a basic treatment. Avoiding aggravating factors is also a basic treatment of AE. Standard medical treatment with a pharmacologic approach may be necessary if basic treatment fails to control symptoms satisfactorily. Recently, more attention is given to a proactive therapeutic by regular intermittent application of low potency steroids or topical calcineurin inhibitors to prevent new flares. Furthermore, various targeted biologics are being introduced for AE control and are proposed as promising therapies. This paper provides a summary of the recent literature on the manangement of AE and a treatment guideline. PMID:26922927

  14. Eczema therapeutics in children: what do the clinical trials say?

    PubMed

    Leung, Theresa N H; Hon, K L

    2015-06-01

    Eczema or atopic dermatitis is a common childhood atopic disease associated with chronicity and impaired quality of life. As there is no cure for the disease, treatment relies on topical and systemic anti-allergic or immunomodulating therapies. Topical corticosteroid, macrolide immunosuppressants, and oral immunomodulating drugs for recalcitrant disease have been the mainstay of therapy. Management of atopic dermatitis must consider the individual symptomatic variability of the disease. Basic therapy is focused on patient/family education, hydrating topical treatment, and avoidance of specific and non-specific provocative factors. Anti-inflammatory treatment based on topical glucocorticosteroids and topical calcineurin inhibitors is used for exacerbation management and more recently in selective cases for proactive therapy. Systemic immunosuppressive treatment is an option for severe refractory cases. Microbial colonisation and superinfection may induce disease exacerbation and justify additional antimicrobial treatment. Adjuvant therapy includes ultraviolet (UV) irradiation preferably with UVA1 or narrowband UVB. Dietary recommendations should be specific and given only when food allergy is confirmed. Allergen-specific immunotherapy against aeroallergens may be useful in selected cases. Parallel use of traditional and proprietary topical and herbal medicine has also been popular in China and many cities in Asia. Complementary and alternative medicine may have a place but evidence-based data are lacking. PMID:25904389

  15. A clinical trial for evaluation of leech application in the management of Vicarcikā (Eczema)

    PubMed Central

    Shankar, K.M. Pratap; Rao, S. Dattatreya; Umar, Shaik Nafeez; Gopalakrishnaiah, V.

    2014-01-01

    Background: Skin diseases are among the most common health problems worldwide and are associated with a considerable burden. Eczema is such a skin ailment which cause psychological, social and financial burden on the patient and their families. Management of eczema with antibiotics, antihistamines, steroids etc., are available but even after their use relapses, recurrences and other complications are very common. Aim: The aim of this study was to assess the efficacy of leech application in the management of vicarcikā (Eczema) with standard clinical parameters viz. Eczema Area and Severity Index (EASI) score, SCORing of Atopic Dermatitis (SCORAD) Index and Dermatology Life Quality Index (DLQI). Materials and Methods: An open labeled clinical trial study without control group was conducted with 27 patients having the classical symptoms of vicarcikā (Eczema), selected as per the inclusion and exclusion criteria from outpatient department and inpatient department sections of Shalya Department, S.V. Ayurvedic Hospital, Tirupati. Minimum four sittings of leech application were carried out with 7 days interval. Pre- and post-treatment evaluation of the patient was done with Eczema Area and Severity Index (EASI) score, SCORing of Atopic Dermatitis (SCORAD) Index and Dermatology Life Quality Index (DLQI). Statistical Analysis: Analysis of the data was done with Student's paired t-test. Results: The total EASI score showed considerable reduction up to 54.45% (P < 0.01) and the SCORAD Index significantly reduced by 55% (P < 0.01). The life quality of the patient calculated by DLQI improved significantly by 62.36% (P < 0.01). Conclusion: Leech application gives significant relief for the symptoms of eczema. The life quality of the patient also improved significantly after leech therapy. No adverse reactions were reported during the entire course of study. PMID:25593404

  16. Complementary and alternative medicines and childhood eczema: a US population-based study.

    PubMed

    Silverberg, Jonathan I; Lee-Wong, Mary; Silverberg, Nanette B

    2014-01-01

    The prevalence of complementary and alternative medicine (CAM) use in US children with eczema is unknown. Furthermore, it is unknown whether CAM use in the United States is associated with higher eczema prevalence. We sought to determine the eczema prevalence in association with CAM usage. We analyzed data from the 2007 National Health Interview Survey that included a nationally representative sample of 9417 children ages 0 to 17 years. Overall, 46.9% (95% confidence interval, 45.6%-48.2%) of children in the United States used 1 or more CAM, of which 0.99% (0.28%-1.71%) used CAM specifically to treat their eczema, including herbal therapy (0.46%), vitamins (0.33%), Ayurveda (0.28%), naturopathy (0.24%), homeopathy (0.20%), and traditional healing (0.12%). Several CAMs used for other purposes were associated with increased eczema prevalence, including herbal therapy (survey logistic regression; adjusted odds ratio [95% confidence interval], 2.07 [1.40-3.06]), vitamins (1.45 [1.21-1.74]), homeopathic therapy (2.94 [1.43-6.00]), movement techniques (3.66 [1.62-8.30]), and diet (2.24 [1.10-4.58]), particularly vegan diet (2.53 [1.17-5.51]). In conclusion, multiple CAMs are commonly used for the treatment of eczema in US children. However, some CAMs may actually be harmful to the skin and be associated with higher eczema prevalence in the United States. PMID:25207686

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

    PubMed Central

    Conceio, Teresa; Diamantino, Fernanda; Coelho, Cline; de Lencastre, Hermnia; Aires-de-Sousa, Marta

    2013-01-01

    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 PortugalLisbon, 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

  18. Treatment of MRSA soft tissue infections: an overview.

    PubMed

    Morgan, M

    2011-12-01

    MRSA is becoming increasingly common worldwide. With the emergence of new highly spreadable strains (community associated or CA-MRSA) novel presentation skin and soft tissue infections (SSTI) are being seen. Recurrent SSTI, including folliculitis, furunculosis and abscesses account for an increasing proportion of SSTI seen in the emergency department. Empirical antimicrobial management choices can be difficult, but clues to the nature of the MRSA may be gleaned from the history and clinical presentation. More severe SSTI due to necrotising fasciitis and purpura fulminans are emerging and warrant the broadest possible empirical Gram-positive cover, ideally with antimicrobials that stop exotoxin production, and sometimes intravenous immunoglobulin to neutralise exotoxins already produced. PMID:22196904

  19. Use of a Robotic Sampler (PIPER) for Evaluation of Particulate Matter Exposure and Eczema in Preschoolers.

    PubMed

    Shah, Lokesh; Mainelis, Gediminas; Ramagopal, Maya; Black, Kathleen; Shalat, Stuart L

    2016-01-01

    While the association of eczema with asthma is well recognized, little research has focused on the potential role of inhalable exposures and eczema. While indoor air quality is important in the development of respiratory disease as children in the U.S. spend the majority of their time indoors, relatively little research has focused on correlated non-respiratory conditions. This study examined the relationship between particulate matter (PM) exposures in preschool age children and major correlates of asthma, such as wheeze and eczema. Air sampling was carried out using a robotic (PIPER) child-sampling surrogate. This study enrolled 128 participants, 57 male and 71 female children. Ages ranged from 3 to 58 months with the mean age of 29.3 months. A comparison of subjects with and without eczema showed a difference in the natural log (ln) of PM collected from the PIPER air sampling (p = 0.049). PIPER's sampling observed an association between the ln PM concentrations and eczema, but not an association with wheezing history in pre-school children. Our findings are consistent with the hypothesis of the role of the microenvironment in mediating atopic dermatitis, which is one of the predictors of persistent asthma. Our findings also support the use of PIPER in its ability to model and sample the microenvironment of young children. PMID:26907317

  20. Use of a Robotic Sampler (PIPER) for Evaluation of Particulate Matter Exposure and Eczema in Preschoolers

    PubMed Central

    Shah, Lokesh; Mainelis, Gediminas; Ramagopal, Maya; Black, Kathleen; Shalat, Stuart L.

    2016-01-01

    While the association of eczema with asthma is well recognized, little research has focused on the potential role of inhalable exposures and eczema. While indoor air quality is important in the development of respiratory disease as children in the U.S. spend the majority of their time indoors, relatively little research has focused on correlated non-respiratory conditions. This study examined the relationship between particulate matter (PM) exposures in preschool age children and major correlates of asthma, such as wheeze and eczema. Air sampling was carried out using a robotic (PIPER) child-sampling surrogate. This study enrolled 128 participants, 57 male and 71 female children. Ages ranged from 3 to 58 months with the mean age of 29.3 months. A comparison of subjects with and without eczema showed a difference in the natural log (ln) of PM collected from the PIPER air sampling (p = 0.049). PIPER’s sampling observed an association between the ln PM concentrations and eczema, but not an association with wheezing history in pre-school children. Our findings are consistent with the hypothesis of the role of the microenvironment in mediating atopic dermatitis, which is one of the predictors of persistent asthma. Our findings also support the use of PIPER in its ability to model and sample the microenvironment of young children. PMID:26907317

  1. Blue Light Phototherapy Kills Methycillin Resistant Staphylococcus Aureus (MRSA)

    NASA Astrophysics Data System (ADS)

    Enwemeka, Chukuka S.; Williams, Debora; Enwemeka, Sombiri K.; Hollosi, Steve; Yens, David

    2010-05-01

    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.

  2. [Estimation of MRSA susceptibility to oxacillin, cefoxitine, vancomycin and daptomycin].

    PubMed

    Gostev, V V; Popenko, L N; Chernen'kaia, T V; Naumenko, Z S; Voroshilova, T M; Zakharova, Iu A; Khokhlova, O E; Kruglov, A N; Ershova, M G; Angelova, S N; Poletaeva, E D; Molchanova, I V; Sidorenko, S V

    2013-01-01

    Prevalence and therapy of infections due to MRSA remain one of the most serious problems in the world. Therefore, correct laboratory identification of the MRSA phenotype based on the use of the marker antibiotic cefoxitine, as a more susceptibile one vs. oxacillin, is of great importance. There is lately being observed a tendency towards emergence of strains with lower susceptibility to the last reserve drugs protecting from MRSA, i. e. vancomycin and daptomycin. Susceptibility of MSRA to these drugs was not investigated in Russia and there are no data on the prevalence of the VISA and hVISA phenotypes. The results of our study on estimation of susceptibility of 316 MRSA isolates from several regions of Russia to oxacillin, cefoxitine, vancomycin and daptomycin are presented herein. It was shown that the ranges of the oxacillin MIC were extremely wide, i. e. 0.5 to 512 mcg/ml, while 2.2 +/- 1% of the isolates was susceptible by the phenotype to oxacillin, in spite of the mecA gene presence. As for cefoxitine, the MRSA isolates were rather resistant to it at the MIC > 16 mcg/ml. The tests with serial microdilutions revealed that 30.7 +/- 7% of the isolates had a critical level of susceptibility to vancomycin at the MIC 2 mcg/ml. The E-tests revealed 1.3 +/- 1% of the isolates which were susceptible at the MIC 2-4 mcg/ml. The MRSA isolates were highly susceptible to daptomycin, while high levels of the MIC (2 mcg/ml) were characteristic of 2.8 +/- 1% of the isolates. Cross reduction of the susceptibility to vancomycin and daptomycin was observed. PMID:24738238

  3. [Antibiotic Resistance of MRSA in the Russian Federation].

    PubMed

    Gostev, V V; Kalinogorskaya, O S; Popenko, L N; Chernenkaya, T V; Naumenko, Z S; Voroshilova, T M; Zakharova, Yu A; Khokhlova, O E; Kruglov, A N; Ershova, M G; Molchanova, I V; Sidorenko, S V

    2015-01-01

    The results of the multicentre trial on estimation of MRSA antibiotic susceptibility to 17 antibiotics are presented. 474 nonrepeting isolates of MRSA (mecA+), collected in 2011-2014 in 10 cities of the Russian Federation were used in the trial. The antibiotic susceptibility was determined by the method of serial microdilutions in broth with estimation of the MICs in accordance with the international standards CLSI 2014 and EUCAST 2014. The highest levels of the MRSA resistance were stated against ciprofloxacin--92%(MIC50 32 mcg/ml), gentamicin--85% (MIC50 128 mcg/ml), erythromycin--54% (MIC50 32-mcg/ml) and clindainycin - 45% (MIC50 0.03 mcg/ml), as well as against rifampicin--38% (MIC50 0.06 mcg/ml). The frequency of MRSA isolated at the vancomycin dose of 2 mcg/ml equaled 26%. No correlation of the decrease in susceptibility to vancomycin and rifampicin was observed. In 5% of MRSA isolated from infected surgical wounds in patients with bone infection or sepsis, there was observed a decrease in the susceptibility to ceftarolin (MIC 2-4 mcg/ml). Co-trimoxasole, fusidic acid (MIC50 0.06 mcg/ml) and mupirocin (MIC50 0.5 mcg/ml) showed high antibacterial activity, 93-98% of the isolates being susceptible to the drugs. No resistance to linezolid and tigecycline was detected. By the associate resistance spectrum, most of the MRSA isolates were characterized by resistance to drugs of 3-7 groups (56%). The phenotypes with simultaneous resistance to drugs of 8-10 groups amounted to 6%. As a whole, 70 variants of associate resistance combinations were detected. PMID:26168679

  4. Aphonia and epiglottitis in neonate with concomitant MRSA skin infection

    PubMed Central

    Noble, Jennifer; Devor, Renee; Rogalski, Francis J; Vergara, Wilfredo; Reddy, Ramalinga P; Bhumbra, Nasreen

    2014-01-01

    We report an unusual case of a neonate with aphonia due to epiglottitis with a concomitant methicillin-resistant Staphylococcus aureus (MRSA) infection of the genitalia and associated septic emboli to the groin area and mouth. We postulate that the MRSA infection caused a transient bacteremia that seeded the epiglottis, likely causing the epiglottitis. In the evaluation of a neonate with aphonia, while the two primary differentials to consider are vocal cord paralysis and laryngeal web, among other considerations is epiglottitis (supraglottitis). PMID:25473587

  5. Fusidic acid in skin infections and infected atopic eczema.

    PubMed

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

    2014-08-01

    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

  6. Comparison of Two Commercial PCR Methods for Methicillin-Resistant Staphylococcus aureus (MRSA) Screening in a Tertiary Care Hospital

    PubMed Central

    Schildgen, Verena; Winterfeld, Ingo; Knüver, Oliver; Schwarz, Katja; Messler, Sabine; Schildgen, Oliver; Mattner, Frauke

    2012-01-01

    Nose/throat-swabs from 1049 patients were screened for MRSA using CHROMagar MRSA, LightCycler Advanced MRSA, and Detect-Ready MRSA. Results were compared to the CHROMagar MRSA results, which was set as reference system. MRSA was detected in 3.05% of the patients with CHROMagar MRSA. LightCycler MRSA Advanced showed a higher clinical sensitivity (84.38%) than Detect-Ready MRSA (57.69%).The negative predictive values were high for both tests (>98%). The specificity and the positive predictive value were higher for the Detect-Ready MRSA test than for the LightCycler MRSA test (99.59% and 78.95% versus 98.52% and 64.29%). For routine screening LightCycler MRSA Advanced proved to be more efficient in our clinical setting as the clinical sensitivity was much higher than the sensitivity of Detect-Ready MRSA. CHROMagar MRSA detected more MRSA positive samples than both PCR methods, leading to the conclusion that the combination of PCR with cultural screening is still the most reliable way for the detection of MRSA. LightCycler MRSA Advanced was faster and needed less hands-on time. The advantage of Detect-Ready MRSA was the additional identification of methicillin-sensitive S.aureus (here in 34.63% of the samples), an information which can be possibly used for reducing the risk of postoperative infections in surgical patients in future. PMID:23028480

  7. Comparison of two commercial PCR methods for methicillin-resistant Staphylococcus aureus (MRSA) screening in a tertiary care hospital.

    PubMed

    Aydiner, Aylin; Lüsebrink, Jessica; Schildgen, Verena; Winterfeld, Ingo; Knüver, Oliver; Schwarz, Katja; Messler, Sabine; Schildgen, Oliver; Mattner, Frauke

    2012-01-01

    Nose/throat-swabs from 1049 patients were screened for MRSA using CHROMagar MRSA, LightCycler Advanced MRSA, and Detect-Ready MRSA. Results were compared to the CHROMagar MRSA results, which was set as reference system. MRSA was detected in 3.05% of the patients with CHROMagar MRSA. LightCycler MRSA Advanced showed a higher clinical sensitivity (84.38%) than Detect-Ready MRSA (57.69%).The negative predictive values were high for both tests (>98%). The specificity and the positive predictive value were higher for the Detect-Ready MRSA test than for the LightCycler MRSA test (99.59% and 78.95% versus 98.52% and 64.29%). For routine screening LightCycler MRSA Advanced proved to be more efficient in our clinical setting as the clinical sensitivity was much higher than the sensitivity of Detect-Ready MRSA. CHROMagar MRSA detected more MRSA positive samples than both PCR methods, leading to the conclusion that the combination of PCR with cultural screening is still the most reliable way for the detection of MRSA. LightCycler MRSA Advanced was faster and needed less hands-on time. The advantage of Detect-Ready MRSA was the additional identification of methicillin-sensitive S.aureus (here in 34.63% of the samples), an information which can be possibly used for reducing the risk of postoperative infections in surgical patients in future. PMID:23028480

  8. Sleep disturbances in adults with eczema are associated with impaired overall health: a US population-based study.

    PubMed

    Silverberg, Jonathan I; Garg, Nitin K; Paller, Amy S; Fishbein, Anna B; Zee, Phyllis C

    2015-01-01

    Sleep disturbances are associated with poor health outcomes in adults. However, little is known about the sleep disturbances that occur in adult eczema. We studied the association between adult eczema and sleep disturbance and their impact on overall health and health care utilization. We used the 2012 National Health Interview Survey, a cross-sectional questionnaire of 34,613 adults. Eczema was associated with higher odds of fatigue (odds ratio (95% confidence interval): 2.97 (2.65-3.34)), regular daytime sleepiness (2.66 (2.34-3.01)), and regular insomnia (2.36 (2.11-2.64)), even after controlling for sleep duration, history of allergic disease, sociodemographics, and body mass index. There were significant interactions between eczema and fatigue, sleepiness, and insomnia as predictors of poorer overall health status, number of sick days, and doctor visits, such that eczema and each of the sleep symptoms were associated with higher odds of poorer outcomes than either eczema or sleep symptoms alone. Latent class analysis was used and identified five classes of fatigue, sleep disturbances, and allergic disorders. Two classes had high probabilities of eczema: one with high probabilities of asthma, hay fever, food allergy, and multiple sleep symptoms and the other with intermediate probability of insomnia alone. Future studies are warranted to better characterize sleep loss in eczema and develop strategies for treatment and prevention. PMID:25078665

  9. RESOLUTION OF CUTANEOUS LEISHMANIASIS AFTER ACUTE ECZEMA DUE TO INTRALESIONAL MEGLUMINE ANTIMONIATE

    PubMed Central

    Vasconcellos, Erica de Camargo Ferreira e; Pimentel, Maria Inês Fernandes; Valete-Rosalino, Cláudia Maria; Madeira, Maria de Fátima; Schubach, Armando de Oliveira

    2014-01-01

    We report a case of a 42 year-old female, who came to a leishmaniasis reference center in Rio de Janeiro, Brazil, presenting a cutaneous leishmaniasis lesion in the right forearm. Treatment with low-dose intramuscular meglumine antimoniate (MA) (5 mg Sb5+/kg/day) was initiated, with improvement after 28 days, although with the development of generalized eczema. After 87 days, the lesion worsened. Patient refused treatment with amphotericin B. MA was then infiltrated in the lesion, in two sessions, resulting in local eczema, with bullae formation; however, twenty days after, both the ulcer and eczema receded. Intralesional administration of MA should be used carefully when previous cutaneous hypersensitivity is detected. PMID:25076440

  10. Exercise-induced bronchocontriction, skin sensitivity, and serum IgE in children with eczema.

    PubMed Central

    Price, J F; Cogswell, J J; Joseph, M C; Cochrane, G M

    1976-01-01

    Forty-two children with eczema were studied for exercise-induced astham (EIA), skin sensitivity to prick testing, blood eosinophil count, and immunoglobulins. 29 had a fall in peak expiratory flow rate after exercise greater than 20% and of these, 23 had symptoms of wheezing. 13 of the eczematous children showed a fall of less than 20%. The children with EIA showed greater cutaneous sensitivity (p less than 0.001) and a higher total serum IgE (p less than 0.025). 3 of the group with a fall of less than 20% had allergic rhinitis with skin sensitivity to grass pollen. The remaining 10 had no clinical evidence of allergic disease, other than eczema and skin sensitivity, and total IgE fell within the normal range. It is suggested that in a proportion of chilren with eczema there is little evidence of reaginic allergy. PMID:1015843

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

    PubMed Central

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

    2012-01-01

    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. PMID:22520913

  12. Comparative Analysis of Fecal Microbiota in Infants with and without Eczema

    PubMed Central

    Hong, Pei-Ying; Lee, Bee Wah; Aw, Marion; Shek, Lynette Pei Chi; Yap, Gaik Chin; Chua, Kaw Yan; Liu, Wen-Tso

    2010-01-01

    Eczema is a chronic form of childhood disorder that is gaining in prevalence in affluent societies. Previous studies hypothesized that the development of eczema is correlated with changes in microbial profile and composition of early life endemic microbiota, but contradictory conclusions were obtained, possibly due to the lack of minimization of apparent non-health related confounders (e.g., age, antibiotic consumption, diet and mode of delivery). In this study, we recruited seven caesarean-delivered and total formula-fed infants, and comparatively examined the early-life endemic microbiota in these infants with and without eczema. Using 16S pyrosequencing, infants' fecal microbiota were observed to comprise Proteobacteria, Firmicutes, Actinobacteria and Bacteroidetes as the four main phyla, and the presence and absence of specific populations within these four phyla are primarily mediated by ageing. Quantitative analysis of bacterial targets on a larger sample size (n = 36 at 1, 3, and 12 months of age) revealed that the abundances of Bifidobacterium and Enterobacteriaceae were different among caesarean-delivered infants with and without eczema, and the bacterial targets may be potential biomarkers that can correlate to the health status of these infants. Our overall findings suggest that the minimization of possible confounders is essential prior to comparative evaluation and correlation of fecal microbiota to health status, and that stool samples collected from caesarean-delivered infants at less than 1 year of age may represent a good cohort to study for potential biomarkers that can distinguish infants with eczema from those without. These findings would greatly facilitate future efforts in understanding the possible pathogenesis behind certain bacterial targets, and may lead to a timely intervention that reduces the occurrence of early life eczema and possibly allergic disorders in later life. PMID:20376357

  13. First Outbreak with MRSA in a Danish Neonatal Intensive Care Unit: Risk Factors and Control Procedures

    PubMed Central

    Ramsing, Benedicte Grenness Utke; Arpi, Magnus; Andersen, Erik Arthur; Knabe, Niels; Mogensen, Dorthe; Buhl, Dorte; Westh, Henrik; stergaard, Christian

    2013-01-01

    Introduction The purpose of the study was to describe demographic and clinical characteristics and outbreak handling of a large methicillin-resistant Staphylococcus aureus (MRSA) outbreak in a neonatal intensive care unit (NICU) in Denmark June 25thAugust 8th 2008, and to identify risk factors for MRSA transmission. Methods Data were collected retrospectively from medical records and the Danish Neobase database. All MRSA isolates obtained from neonates, relatives and NICU health care workers (HCW) as well as environmental cultures were typed. Results During the 46 day outbreak period, 102 neonates were admitted to the two neonatal wards. Ninety-nine neonates were subsequently sampled, and 32 neonates (32%) from 25 families were colonized with MRSA (spa-type t127, SCCmec V, PVL negative). Thirteen family members from 11 of those families (44%) and two of 161 HCWs (1%) were colonized with the same MRSA. No one was infected. Five environmental cultures were MRSA positive. In a multiple logistic regression analysis, nasal Continuous Positive Airway Pressure (nCPAP) treatment (p?=?0.006) and Caesarean section (p?=?0.016) were independent risk factors for MRSA acquisition, whereas days of exposure to MRSA was a risk factors in the unadjusted analysis (p?=?0.04). Conclusions MRSA transmission occurs with high frequency in the NICU during hospitalization with unidentified MRSA neonates. Caesarean section and nCPAP treatment were identified as risk factors for MRSA colonization. The MRSA outbreak was controlled through infection control procedures. PMID:23825581

  14. Transferable vancomycin resistance in a community-associated MRSA lineage.

    PubMed

    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

    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

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

    ERIC Educational Resources Information Center

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

    2007-01-01

    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…

  16. Reduced vancomycin susceptibility in porcine ST9 MRSA isolates

    PubMed Central

    Kwok, Gabriella M. L.; O'Donoghue, Margaret M.; Doddangoudar, Vijaya C.; Ho, Jeff; Boost, Maureen V.

    2013-01-01

    Porcine strains of livestock-associated methicillin resistant Staphylococcus aureus (LA-MRSA) have been recognized in many countries and have been shown to be able to cause human infection. Resistance to non-beta lactam antibiotics has been reported but non-susceptibility to vancomycin, which is known to occur in human MRSA, has so far not been observed in LA-MRSA. Such resistance is typically fairly low level involving changes in the cell wall thickness. The development of resistance is usually preceded by presence of a sub-population having an increased MIC, which is selected for by exposure to vancomycin. This study investigated vancomycin susceptibility of one hundred porcine MRSA isolates using three MIC methods including spiral gradient endpoint (SGE) technique which allows visualization of more resistant sub-populations. SGE revealed 16 strains with an MIC above 2.0 mg/L, of which 14 were determined to have MIC 4 mg/L by agar dilution (AD). SGE revealed a further two isolates with MIC < 2 mg/L had a sub-population >2 mg/L. In addition, trailing endpoints not reaching resistance were present in 26 isolates with MIC < 2 mg/L. Sequencing of the genes of the VraSR/GraSR two component systems of ten of the resistant strains for comparison with susceptible strains revealed changes, including the presence of stop codons, in vraS and graR, but these were not consistent in all isolates. Other genetic changes may contribute to vancomycin non-susceptibility and require investigation. As failure to respond to treatment has been reported in clinical isolates with MIC > 1.5 mg/L, the presence of vancomycin non-susceptibility in porcine isolates is of concern and further monitoring of LA-MRSA is essential. PMID:24298270

  17. Higher incidence of perineal community acquired MRSA infections among toddlers

    PubMed Central

    2011-01-01

    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. PMID:22032513

  18. Epidemiology of MRSA and current strategies in Europe and Japan

    PubMed Central

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

    2010-01-01

    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. PMID:20204100

  19. Detection and genetic characterization of PVL-positive ST8-MRSA-IVa and exfoliative toxin D-positive European CA-MRSA-Like ST1931 (CC80) MRSA-IVa strains in Bangladesh.

    PubMed

    Paul, Shyamal Kumar; Ghosh, Souvik; Kawaguchiya, Mitsuyo; Urushibara, Noriko; Hossain, Mohammad Akram; Ahmed, Salma; Mahmud, Chand; Jilani, Md Shariful Alam; Haq, Jalaluddin Ashraful; Ahmed, Abdullah Akhtar; Kobayashi, Nobumichi

    2014-08-01

    Severe skin lesions caused by Staphylococcus aureus infection are associated with production from bacterial cells of Panton-Valentine leukocidin (PVL), a typical virulence factor of community-acquired methicillin-resistant S. aureus (CA-MRSA), as well as other toxins represented by exfoliative toxins. Through a retrospective study of 26 S. aureus strains isolated from skin lesions of diabetic patients admitted to a hospital in Bangladesh, 2 PVL-gene-positive MRSA-IVa strains and 8 PVL-negative, exfoliative toxin D (ETD) gene (etd)-positive MRSA-IVa strains were isolated. A PVL-positive MRSA-IVa strain had a type I arginine catabolic mobile element (ACME), belonged to ST8/agr-type I/spa-type t121 (a variant of t008), and harbored blaZ, tet(K), msrA, and aph(3')-IIIa, which are mostly typical characteristics found in USA300, a predominant CA-MRSA clone in the United States. Another PVL-positive MRSA strain, belonging to ST1929 (CC88)/agr-type III/spa-type t3341, was negative for ACME, but possessed blaZ and tet(K). The etd-positive MRSA-IVa strains possessed the epidermal cell differentiation inhibitor B (EDIN-B)-encoding gene (edinB) and belonged to ST1931 (CC80)/agr-type III/spa-type t11023 (a variant of t044), which was genetic trait similar to that of the European CA-MRSA ST80 clone. However, unlike the European ST80 strains, the etd-positive MRSA strains detected in the present study harbored seb, sek, and seq, while they were negative for tet(K), aph(3')-IIIa, and fusB, showing susceptibility to fusidic acid. These findings suggested that etd-positive ST1931 MRSA strains belong to the same lineage as the European ST80 MRSA clone, evolving from a common ancestral clone via acquisition of a different pathogenicity island. This is the first report of a USA300-like MRSA-IV strain, PVL-positive ST1929 (CC88) MRSA-IV, and European ST80 CA-MRSA-like etd-positive ST1931 (CC80) MRSA-IV strains isolated in Bangladesh. PMID:24552553

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

    PubMed Central

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

    2014-01-01

    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. PMID:25054078

  1. Molecular Typing of MRSA and of Clinical Staphylococcus aureus Isolates from Iaşi, Romania

    PubMed Central

    Monecke, Stefan; Müller, Elke; Dorneanu, Olivia Simona; Vremeră, Teodora; Ehricht, Ralf

    2014-01-01

    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. PMID:24846009

  2. Predictors of agr Dysfunction in Methicillin-Resistant Staphylococcus aureus (MRSA) Isolates among Patients with MRSA Bloodstream Infections ?

    PubMed Central

    Butterfield, Jill M.; Tsuji, Brian T.; Brown, Jack; Ashley, Elizabeth Dodds; Hardy, Dwight; Brown, Kristen; Forrest, Alan; Lodise, Thomas P.

    2011-01-01

    Despite emerging evidence that dysfunction in the accessory gene regulator (agr) locus is associated with deleterious outcomes among patients treated with vancomycin for methicillin-resistant Staphylococcus aureus (MRSA) infections, factors predictive of agr dysfunction have not been evaluated. This study describes the epidemiology of agr dysfunction, identifies predictors of agr dysfunction in MRSA isolates among those with MRSA bloodstream infections, and describes the relationship between agr dysfunction and other microbiologic phenotypes. A cross-sectional study of patients with MRSA bloodstream infections at two institutions in upstate New York was performed. Clinical data on demographics, comorbidities, disease severity, hospitalization history, and antibiotic history were collected. Microbiologic phenotypes, including agr dysfunction, MIC values by broth microdilution (BMD) and Etest, and vancomycin heteroresistance (hVISA) were tested. Multivariable analyses were performed to identify factors predictive of agr dysfunction. Among 200 patients with an MRSA bloodstream infection, the proportion of strains with agr dysfunction was 31.5%. The distribution of MICs determined by both BMD and Etest were equivalent across agr groups, and there was no association between agr dysfunction and the presence of hVISA. Severity of illness, comorbidities, and hospitalization history were comparable between agr groups. In the multivariate analysis, prior antibiotic exposure was the only factor of variables studied found to be predictive of agr dysfunction. This relationship was predominantly driven by prior beta-lactam and fluoroquinolone administration in the bivariate analysis. Identifying these institution-specific risk factors can be used to develop a process to assess the risk of agr dysfunction and guide empirical antibiotic therapy decisions. PMID:21930887

  3. Antibacterial activity of Lactobacillus acidophilus and Lactobacillus casei against methicillin-resistant Staphylococcus aureus (MRSA).

    PubMed

    Karska-Wysocki, Barbara; Bazo, Mari; Smoragiewicz, Wanda

    2010-10-20

    Methicillin-resistant Staphylococcus aureus (MRSA) is a multidrug-resistant microorganism and the principal nosocomial pathogen worldwide. The antibacterial activity of lactic acid bacteria against MRSA from ten human clinical isolates as well as MRSA standard strain ATCC 43300 was tested in vitro. The Lactobacillus (Lb.) strains (Lb. acidophilus CL1285(®) and Lb. casei LBC80R) as pure cultures, which came from commercial food products were employed. The growth inhibitory effect produced by the antimicrobial activity of the lactic acid bacteria on the MRSA strains was tested on solid medium using agar diffusion methods as well as a using a liquid medium procedure that contained a mixture of MRSA and lactic acid bacteria cultures. In the latter instance, we were able to demonstrate that the direct interaction of lactic acid bacteria and MRSA in such a mixture led to the elimination of 99% of the MRSA cells after 24 h of their incubation at 37°C. PMID:20116228

  4. Isolation of meticillin-resistant Staphylococcus aureus (MRSA) from swine in Japan.

    PubMed

    Baba, Kotaro; Ishihara, Kanako; Ozawa, Manao; Tamura, Yutaka; Asai, Tetsuo

    2010-10-01

    Meticillin-resistant Staphylococcus aureus (MRSA) sequence type (ST) 398 is widely prevalent in swine in Europe and North America. To determine the prevalence of MRSA, and specifically ST398, in Japanese swine, a total of 115 nasal swabs and 115 faecal samples from swine reared at 23 farms located in eastern Japan were investigated. MRSA was isolated from a nasal sample (0.9%) but not from any faecal samples. The strain of MRSA was classified as ST221 by multilocus sequence typing and as t002 by spa typing. The MRSA isolate exhibited resistance to ampicillin, meticillin and dihydrostreptomycin. Interestingly, it remained susceptible to cefazolin, ceftiofur, imipenem, gentamicin, kanamycin, chloramphenicol, oxytetracycline, erythromycin, azithromycin, tylosin, vancomycin, enrofloxacin and trimethoprim. The prevalence of MRSA amongst swine was low and MRSA ST398 was not recovered in the present study. PMID:20692816

  5. Identifying chinese herbal medicine network for eczema: implications from a nationwide prescription database.

    PubMed

    Chen, Hsing-Yu; Lin, Yi-Hsuan; Hu, Sindy; Yang, Sien-Hung; Chen, Jiun-Liang; Chen, Yu-Chun

    2015-01-01

    Eczema is a highly prevalent dermatological disease that can severely affect the patient's quality of life. Chinese herbal medicine (CHM) is commonly used in combination for eczema due to the complicated pathogenesis. This study aimed to identify a CHM network for the treatment of eczema by using a nationwide database. During 2011, 381,282 CHM prescriptions made for eczema (ICD-9-CM 692.x) were obtained from the National Health Insurance Research Database (NHIRD) in Taiwan and analyzed by using association rule mining and social network analysis. Among 661 available CHMs, 44 important combinations were identified. Among the CHM networks, seven clusters with the predominant traditional Chinese medicine (TCM) pattern were recognized. The largest CHM cluster was used to treat the wind-dampness-heat pattern, and Xiao-Feng-San (24.1% of all prescriptions) was the core of this cluster with anti-inflammation, antioxidation, and antiallergic effects. Lonicera japonica (11.0% of all prescriptions) with Forsythia suspense (17.0% of all prescriptions) was the most commonly used CHM combination and was also the core treatment for treating the heat pattern, in which an antimicrobial effect is found. CHM network analysis is helpful for TCM doctors or researchers to choose candidates for clinical practice or further studies. PMID:25685167

  6. Influence of weather and climate on subjective symptom intensity in atopic eczema

    NASA Astrophysics Data System (ADS)

    Vocks, E.; Busch, R.; Fröhlich, C.; Borelli, S.; Mayer, H.; Ring, J.

    The frequent clinical observation that the course of atopic eczema, a skin disease involving a disturbed cutaneous barrier function, is influenced by climate and weather motivated us to analyse these relationships biometrically. In the Swiss high-mountain area of Davos the intensity of itching experienced by patients with atopic eczema was evaluated and compared to 15 single meteorological variables recorded daily during an entire 7-year observation period. By means of univariate analyses and multiple regressions, itch intensity was found to be correlated with some meteorological variables. A clear-cut inverse correlation exists with air temperature (coefficient of correlation: -0.235, P<0.001), but the effects of water vapour pressure, air pressure and hours of sunshine are less pronounced. The results show that itching in atopic eczema is significantly dependent on meteorological conditions. The data suggest that, in patients with atopic eczema, a certain range of thermo-hygric atmospheric conditions with a balance of heat and water loss on the skin surface is essential for the skin to feel comfortable.

  7. Identifying Chinese Herbal Medicine Network for Eczema: Implications from a Nationwide Prescription Database

    PubMed Central

    Chen, Hsing-Yu; Lin, Yi-Hsuan; Hu, Sindy; Yang, Sien-hung; Chen, Jiun-liang; Chen, Yu-Chun

    2015-01-01

    Eczema is a highly prevalent dermatological disease that can severely affect the patient's quality of life. Chinese herbal medicine (CHM) is commonly used in combination for eczema due to the complicated pathogenesis. This study aimed to identify a CHM network for the treatment of eczema by using a nationwide database. During 2011, 381,282 CHM prescriptions made for eczema (ICD-9-CM 692.x) were obtained from the National Health Insurance Research Database (NHIRD) in Taiwan and analyzed by using association rule mining and social network analysis. Among 661 available CHMs, 44 important combinations were identified. Among the CHM networks, seven clusters with the predominant traditional Chinese medicine (TCM) pattern were recognized. The largest CHM cluster was used to treat the wind-dampness-heat pattern, and Xiao-Feng-San (24.1% of all prescriptions) was the core of this cluster with anti-inflammation, antioxidation, and antiallergic effects. Lonicera japonica (11.0% of all prescriptions) with Forsythia suspense (17.0% of all prescriptions) was the most commonly used CHM combination and was also the core treatment for treating the heat pattern, in which an antimicrobial effect is found. CHM network analysis is helpful for TCM doctors or researchers to choose candidates for clinical practice or further studies. PMID:25685167

  8. Comparison of cellular and humoral immunoassays for the assessment of summer eczema in horses

    Technology Transfer Automated Retrieval System (TEKTRAN)

    The objective of this study was to compare and analyze three common diagnostic methods for summer eczema (SE) in horses, an allergic dermatitis caused by bites of Culicoides spp. Nine horses with a medical history of SE and nine control animals were intradermally challenged with whole body extracts ...

  9. Goeckerman Therapy for the Treatment of Eczema: A Practical Guide and Review of Efficacy

    PubMed Central

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

    2013-01-01

    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 UVB 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

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

    PubMed

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

    2013-02-01

    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

  11. Serum fatty acid profile does not reflect seafood intake in adolescents with atopic eczema

    PubMed Central

    Barman, Malin; Jonsson, Karin; Sandin, Anna; Wold, Agnes E; Sandberg, Ann-Sofie

    2014-01-01

    Aim Long-chain polyunsaturated fatty acids (LCPUFAs) are immunomodulatory, but their role in allergy development is controversial. We investigated whether proportions of LCPUFAs in serum phospholipids were related to allergic diagnosis, seafood intake and LCPUFA proportions in cord blood. Methods Serum was obtained from 148 birth cohort children at 13 years of age. Forty had atopic eczema, 53 had respiratory allergy, and 55 were nonallergic. Proportions of LCPUFAs were determined in serum phospholipids; cord blood from 128 of the individuals was previously analysed. Seafood intake was estimated using questionnaires. Results Allergic and nonallergic individuals did not differ significantly regarding individual LCPUFAs. However, arachidonic acid over docosahexaenoic acid (DHA) ratio was higher in allergic, compared with nonallergic, adolescents. In nonallergic individuals, LCPUFA proportions in cord serum and adolescent serum correlated weakly. In individuals with atopic eczema and respiratory allergy, these correlations were weak or absent. A moderate correlation between seafood intake and serum DHA was seen in nonallergic individuals and those with respiratory allergy, but not in those with atopic eczema. Conclusion Serum LCPUFA pattern was similar in allergic and nonallergic adolescents. Fatty acid metabolism may be altered in atopic eczema subjects, suggested by poor correlations between fatty acid intake and serum levels. PMID:24837739

  12. Harmonising Outcome Measures for Eczema (HOME). Report from the First International Consensus Meeting (HOME 1), 24 July 2010, Munich, Germany.

    PubMed

    Schmitt, J; Williams, H

    2010-12-01

    Current clinical research in eczema (atopic dermatitis) is hampered by a profusion of outcome measures, most of which have not been developed or tested adequately. The first Harmonising Outcome Measures for Eczema meeting (HOME 1) was an exploratory meeting to determine whether there was sufficient interest and enthusiasm in the international scientific community to form a collaborative group to define a minimum set of core outcomes for future eczema (atopic dermatitis) research. The meeting was open to all participants of the 6th Georg Rajka Symposium/International Symposium on Atopic Dermatitis/New Trends in Allergy VII meeting in Munich, 22-24 July 2010. Approximately 40 individuals attended. Prior to the meeting, an international Delphi exercise was performed to develop consensus-based sets of core outcome domains for eczema for 'controlled trials' and 'clinical recordkeeping'. The results of this Delphi exercise were presented at the meeting and critically discussed by the attendees. The constructive group discussion identified several important issues for future eczema outcomes research such as the degree to which patients and carers can be involved and the importance of involving colleagues from countries not represented at the meeting. In summary, this exploratory meeting indicated a genuine interest in the academic eczema community to form an international multiprofessional group dedicated to harmonizing outcomes research in eczema. The group decided to continue collaboratively with the HOME initiative. PMID:21137114

  13. Analysis of familial aggregation of atopic eczema and other atopic diseases by ODDS RATIO regression models.

    PubMed

    Diepgen, T L; Blettner, M

    1996-05-01

    In order to determine the relative importance of genetics and the environment on the occurrence of atopic diseases, we investigated the familial aggregation of atopic eczema, allergic rhinitis, and allergic asthma in the relatives of 426 patients with atopic eczema and 628 subjects with no history of eczema (5,136 family members in total). Analyses were performed by regression models for odds ratios (OR) allowing us to estimate OR for the familial aggregation and simultaneously to adjust for other covariates. Three models were analyzed assuming that the OR i) is the same among any two members of a family, ii) depends on different familial constellations, i.e., whether the pairs are siblings, parents, or parent/sibling pairs, and iii) is not the same between the father and the children and between the mother and the children. The OR of familial aggregation for atopic eczema was 2.16 (95% confidence interval (95%-CI) 1.58-2.96) if no distinction was made between the degree of relationship. Further analyses within the members of the family showed a high OR among siblings (OR = 3.86; 95%-CI 2.10-7.09), while the OR between parents and siblings was only 1.90 (95%-CI 1.31-2.97). Only for atopic eczema was the familial aggregation between fathers and siblings (ms: OR = 2.66; fs: OR = 1.29). This can be explained by stronger maternal heritability, shared physical environment of mother and child, or environmental events that affect the fetus in utero. Since for all atopic diseases a stronger correlation was found between siblings than between siblings and parents, our study indicates that environmental factors, especially during childhood, seem to explain the recently observed increased frequencies of atopic diseases. PMID:8618061

  14. A cosmeceutical formulation based on boswellic acids for the treatment of erythematous eczema and psoriasis

    PubMed Central

    Togni, Stefano; Maramaldi, Giada; Di Pierro, Francesco; Biondi, Massimo

    2014-01-01

    Background Boswellic acids (BAs) show anti-inflammatory properties in a variety of inflammatory diseases, including rheumatoid arthritis, osteoarthritis, and asthma. A topical administration route is currently used to deliver active compounds in psoriatic and eczematous patients. In this double-blind study we compare a novel BA formulation (containing Bosexil, INCI [International Nomenclature of Cosmetic Ingredients]: lecithin, Boswellia serrata resin extract) with a placebo formulation. A third arm of the trial received a formulation of Vaccinium myrtillus seed oil, previously demonstrated as an effective local treatment for psoriatic lesions. Methods Patients with psoriasis or erythematous eczema were randomly assigned, in a 1:1:1 ratio, to Bosexil, V. myrtillus seed oil, or placebo. In order to evaluate the effects of treatment, the changes of scales and erythema from diagnosis to the end of treatment were scored in psoriatic patients, while changes in itch and erythema were analyzed for erythematous eczema patients. Psoriasis Area Severity Index and Eczema Area and Severity Index scores were also calculated. Results In patients with psoriasis, scales and erythema improved both with Bosexil and the V. myrtillus seed oil treatment in comparison with placebo. In particular, the treatment with Bosexil formulation improved scales (70% of cases) and erythema (50% of cases) without any case of worsening. In patients with eczema, the administration of placebo did not result in any improvement in 90% of cases, and in the remaining 10% worsened both itch and erythema. Bosexil formulation improved both itch (60% of cases) and erythema (60% of cases) without any case of worsening. V. myrtillus seed oil improved itch and erythema in 66.7% and 77.8% of patients, respectively. Conclusion A topical formulation of Bosexil may be promising for the treatment of psoriasis and erythematous eczema. Long-term studies are recommended to evaluate the adherence to this topical treatment and its clinical benefits in real life. PMID:25419153

  15. A Traditional Diet Is Associated with a Reduced Risk of Eczema and Wheeze in Colombian Children

    PubMed Central

    Cepeda, Alfonso M.; Del Giacco, Stefano R.; Villalba, Sara; Tapias, Elmy; Jaller, Rodolfo; Segura, Ana María; Reyes, Gloria; Potts, James; Garcia-Larsen, Vanessa

    2015-01-01

    Background: Diet might influence the risk of allergic diseases. Evidence from developing countries with high prevalence of childhood asthma is scant. Methods: Information on wheeze, rhinitis, and eczema was collected from 3209 children aged 6–7 years in 2005, who were taking part in the International Study on Asthma and Allergy in Children (ISAAC) in Colombia. Intake frequency of twelve food groups was assessed. Associations between each food group and current wheeze, rhino-conjunctivitis, and eczema were investigated with multiple logistic regressions, adjusting for potential confounders. Simes’ procedure was used to test for multiple comparisons. Results: 14.9% of children reported wheeze in the last 12 months, 16% rhino-conjunctivitis, and 22% eczema. Eczema was negatively associated with consumption of fresh fruits and pulses three or more times per week (adjusted Odds ratio (aOR): 0.64; 95% Confidence Interval (CI): 0.49 to 0.83; p value = 0.004; and aOR: 0.62, 95% CI: 0.47 to 0.80; p value < 0.001, respectively). Current wheeze was negatively associated with intake of potatoes (aOR: 0.44, 95% CI: 0.31 to 0.62, p value = 0.005), whilst this outcome was positively associated with consumption of fast food (aOR: 1.76, 95% CI: 1.32 to 2.35, p value = 0.001). These associations remained statistically significant after controlling for multiple comparisons. Conclusions: A traditional diet might have a protective effect against eczema and wheeze in Colombian children, whilst intake of fast foods increases this risk. PMID:26121530

  16. Effect of contact precautions for MRSA on patient satisfaction scores.

    PubMed

    Livorsi, D J; Kundu, M G; Batteiger, B; Kressel, A B

    2015-07-01

    Contact precautions may have an adverse effect on a patient's hospital experience and the delivery of care. This case-control study compared patient satisfaction scores between 70 patients isolated for MRSA and 139 non-isolated patients. Based on an adjusted analysis, there was no difference in patient satisfaction between the two groups. Age and educational status were found to affect patient satisfaction. PMID:25799481

  17. Patients' feelings about hand washing, MRSA status and patient information.

    PubMed

    Duncan, Christopher Paul; Dealey, Carol

    The purpose of this study was to explore patient opinion about asking healthcare professionals to wash their hands before a clinical procedure and to explore if methicillin-resistant Staphylococcus aureus (MRSA) status and access to patient information about infection control would influence the patients' anxiety about asking. A descriptive survey was undertaken using a semi-structured questionnaire. The questionnaire was distributed to a randomized convenience sample of 185 inpatients across all departments of an acute NHS Trust hospital (response rate 58.9%). Spearman's rank order and Kendall Tau-b tests were used to analyse specific correlations. Respondents were more confident than anxious about being involved in a campaign that empowered patients to ask staff to wash their hands. Patients were more anxious to ask if their previous admission episodes were fewer, if their knowledge of MRSA was high and if there was less information about infection control available. Patients who had contracted MRSA in the past were less anxious, as they had a better understanding of the disease. In addition, more patients felt less anxious about asking staff to wash their hands if staff wore a badge saying 'It's OK to ask'. PMID:17353833

  18. MRSA in Africa: Filling the Global Map of Antimicrobial Resistance

    PubMed Central

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

    2013-01-01

    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

  19. Cost-effectiveness of different MRSA screening methods.

    PubMed

    Kunori, T; Cookson, B; Roberts, J A; Stone, S; Kibbler, C

    2002-07-01

    We describe a model to examine the cost-effectiveness of various laboratory-screening approaches to detect methicillin-resistant Staphylococcus aureus (MRSA). A critical literature review was used to derive relevant data on the sensitivity (X), specificity (S) and time to result (T) of different tests. Additional cost information was provided by a hospital. Tests were considered in four interactive groups based on a hierarchy of procedures used in laboratories. X, S and Ts of screening tests were then used in formulae to calculate effectiveness for the various tests. The model was developed to explore the effects on MRSA infection acquisition of differing X, S and T for the different tests in detecting MRSA colonized patients admitted to a high-risk unit such as an intensive care unit. It was concluded that taking a sample from the nose alone and inoculating directly on to Ciprofloxacin Baird-Parker agar without broth incubation and confirmation by a Pastorex Staph-Plus test without any methicillin resistance confirmation test was the most cost-effective approach. The complexity of designing this apparently simple scenario is apparent, and we describe many other factors that would need to be considered to refine this model further. However, this and other models should aid the debate and development of more cost-effective screening strategies given the lack of standardization or agreement concerning so many of the variables within the UK and elsewhere. PMID:12144798

  20. 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.

    PubMed

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

    2007-08-01

    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 care-associated MRSA, and HA-MRSA) for the carriage of pvl and determined the genotypic characteristics of all pvl-positive isolates identified. All 1,389 MRSA isolates were investigated by antibiogram-resistogram typing and SmaI DNA macrorestriction analysis. pvl-positive isolates were further characterized by multilocus sequence typing and SCCmec, agr, and toxin gene typing. Twenty-five (1.8%) MRSA isolates belonging to six genotypes (ST30, ST8, ST22, ST80, ST5, and ST154) harbored pvl. Nineteen of these (76%) were CA-MRSA isolates, but a prospective study of MRSA isolates from 401 patients showed that only 6.7% (2/30) of patients with CA-MRSA yielded pvl-positive isolates. Thus, pvl cannot be used as a sole marker for CA-MRSA. Fifty-two percent of pvl-positive MRSA isolates were recovered from patients with skin and soft tissue infections; thirty-six percent were from patients of non-Irish ethnic origin, reflecting the increasing heterogeneity of the Irish population due to immigration. All 25 pvl-positive isolates carried SCCmec IV; 14 (56%) harbored SCCmec IV.1 or IV.3, and the remaining 11 isolates could not be subtyped. This study demonstrates that pvl is not a reliable marker for CA-MRSA in Ireland and reveals the emergence and importation of diverse genotypes of pvl-positive MRSA in Ireland. PMID:17581935

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

    PubMed Central

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

    2012-01-01

    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. PMID:22822349

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

    PubMed Central

    Török, M. Estée; 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

    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. PMID:24788657

  3. Skin prick test to foods in childhood atopic eczema: pros and cons

    PubMed Central

    2013-01-01

    Skin prick tests are the first investigation in allergy diagnostics and their use is described in all the guidelines on atopic eczema. However, the clinical usefulness of skin prick tests is the subject of great debate. On the one hand, skin prick tests allow the identification both of individuals at risk for food allergy and of the allergen inducing the eczematous flare. On the other hand, when performed by a non-specific specialist, positive skin prick tests to foods may wrongly lead to prolonged elimination diets, which may induce nutritional deficiencies and perhaps loss of tolerance to the avoided foods. Furthermore, skin prick tests increase health costs. A consensus on this topic has not yet been reached. Considering the diversity of clinical stages in which it occurs, atopic eczema presentation should be the starting point to determine whether or not skin prick tests should be carried out. PMID:23902622

  4. [Optimized interval treatment of eczema with fluprednidene. A multicenter double-blind study].

    PubMed

    Mahrle, G; Wemmer, U; Matthies, C

    1989-09-15

    In a multicenter double-blind study, 44 patients suffering from eczema were bilaterally treated with 0.1% fluprednidene-21-acetate over 21 days. Continuous application twice a day was compared with intermittent therapy, i.e. 1 day intermission (15 patients), 2 days intermission (16 patients) and 3 days intermission (13 patients) using the cream base. Final evaluation was based on 11 criteria. All regimens, continuous and intermittent, proved effective (at least 90% reduction of the lesions). Treatment with 3 days intermission showed the same favorable results as continuous application, although the amount of glucocorticoids applied was 75% less. Measurements of the skin fold thickness (SFT) in healthy controls did not indicate any atrophy after treatment with fluprednidene under the same conditions as the eczema patients or under occlusion for up to 21 days. Clobetasol-17-propionate, in contrast, significantly reduced the SFT already after application of only 1 week. PMID:2683439

  5. Skin prick test to foods in childhood atopic eczema: pros and cons.

    PubMed

    Caffarelli, Carlo; Dondi, Arianna; Povesi Dascola, Carlotta; Ricci, Giampaolo

    2013-01-01

    Skin prick tests are the first investigation in allergy diagnostics and their use is described in all the guidelines on atopic eczema. However, the clinical usefulness of skin prick tests is the subject of great debate. On the one hand, skin prick tests allow the identification both of individuals at risk for food allergy and of the allergen inducing the eczematous flare. On the other hand, when performed by a non-specific specialist, positive skin prick tests to foods may wrongly lead to prolonged elimination diets, which may induce nutritional deficiencies and perhaps loss of tolerance to the avoided foods. Furthermore, skin prick tests increase health costs. A consensus on this topic has not yet been reached. Considering the diversity of clinical stages in which it occurs, atopic eczema presentation should be the starting point to determine whether or not skin prick tests should be carried out. PMID:23902622

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

    PubMed

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

    2012-01-01

    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

  7. Proof of efficacy of Kamillosan(R) cream in atopic eczema.

    PubMed

    Patzelt-Wenczler, R; Ponce-Pöschl, E

    2000-04-19

    Kamillosan(R) cream contains chamomile extract as active principle manufactured from the chamomile sort Manzana which is rich in active principles and has been proved not to exhibit a chamomile-related allergen potential. For this reason Kamillosan(R) cream is suited for local therapy of atopic eczema. In a partially double-blind, randomized study carried out as a half-side comparison, Kamillosan(R) cream was tested vs. 0.5% hydrocortisone cream and the vehicle cream as placebo in patients suffering from medium-degree atopic eczema. After a 2-week treatment Kamillosan(R) cream showed a mild superiority towards 0.5% hydrocortisone and a marginal difference as compared to placebo. PMID:10799352

  8. Occurrence of MRSA in air and housing environment of pig barns.

    PubMed

    Friese, Anika; Schulz, Jochen; Hoehle, Laura; Fetsch, Alexandra; Tenhagen, Bernd-Alois; Hartung, Joerg; Roesler, Uwe

    2012-07-01

    A high prevalence of MRSA among farm animals, especially pigs, has been observed for some time. However, knowledge on transmission routes of MRSA in livestock production is still scarce. Therefore, the aim of this study was to determine the occurrence of MRSA in pig house air as well as in samples from pigs and their housing environment in 27 MRSA positive pig barns of different sizes and production types. In 85.2% of all barns MRSA was detected in the animal house air. Impingement turned out to be a more sensitive sampling technique than filtration. Other environmental samples such as boot swabs or faeces showed prevalences of MRSA from 55.6% to 85.2% at sample level. The level of MRSA was 88.3% for pooled and 82.1% for single nasal swabs, in skin swabs the one was 87.7%, the others was 78.7%. Spa typing of isolates from air and nasal swabs showed predominantly spa types t011 and t034. MRSA prevalences in pigs as well as in various environmental samples were significantly higher in fattening farms than in breeding farms. This study provides good reference that there could be an airborne transmission of MRSA within pig herds indicating a potential contamination of the environment of barns. PMID:22386671

  9. Zeroing in on methicillin-resistant Staphylococcus aureus: US Department of Veterans Affairs' MRSA Prevention Initiative.

    PubMed

    Kralovic, Stephen M; Evans, Martin E; Simbartl, Loretta A; Ambrose, Meredith; Jain, Rajiv; Roselle, Gary A

    2013-05-01

    Implementation of a methicillin-resistant Staphylococcus aureus (MRSA) Prevention Initiative within US Department of Veterans Affairs medical facilities was associated with a significant reduction in MRSA health care-associated infection (HAI) rates nationwide. The first 36 months of data from the Initiative were analyzed to determine how many facilities reported zero MRSA HAIs each month. From October 2007 through September 2010, there was a 37.6% increase nationwide in the number of facilities achieving zero MRSA HAIs each month. PMID:23102985

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

    PubMed Central

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

    2011-01-01

    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

  11. Prevalence of MRSA Nasal Carriage in Patients Admitted to a Tertiary Care Hospital in Southern India

    PubMed Central

    Abdulkader, Jasmine Kulapurathu; Sugumar, Madhan; Rajagopal, Girija Kalarikkal

    2016-01-01

    Introduction Infections with MRSA, both community and hospital acquired, are well established and the source of infection is often a carrier. There are very few studies showing the magnitude of MRSA nasal colonization among healthy persons from the community. This study was conducted to detect the prevalence of MRSA nasal carriage in patients who did not have any known risk factors associated with HA- MRSA colonization, admitted to a tertiary care centre in Kerala. Materials and Methods Nasal swabs were collected from patients within 24 hours of admission. Specimen were inoculated on chromogenic agar (HiCrome MeReSa agar-HiMedia) for MRSA screening. Isolates were then subjected to antibiotic sensitivity tests, SCCmec typing and PVL gene detection. Results Out of 683 patients, 16 carried MRSA in their nares (2.3%). Of the 16 strains 13 (81.25 %) strain were SCCmec type III and one belonged to SCCmec type IV (6.25 %). Two strains failed to amplify SCCmec genes. Three strains carried genes for PVL toxin (18.75%). Conclusion With a better understanding of the complex epidemiology of MRSA it is increasingly apparent that demarcations between the HA and CA phenotypes are not as clear cut as previously thought. In this study of nasal carriage of MRSA in the community we have demonstrated prevalence consistent with published data. Most isolates however were shown to belong to the type conventionally assigned to HA-MRSA. PMID:27042461

  12. Hospital-associated MRSA and antibiotic resistance-what have we learned from genomics?

    PubMed

    Lindsay, Jodi A

    2013-08-01

    In many parts of the world, MRSA are responsible for a high proportion of S. aureus infections in patients in contact with healthcare. Molecular studies have shown this is due to one or more MRSA clones that have become endemic in each hospital or healthcare facility, resulting in hospital- or healthcare-associated MRSA (HA-MRSA). The infection rate and clones responsible for HA-MRSA can vary substantially in different geographical locations. Molecular methods have allowed clones to be categorized, as well as the opportunity to track the evolution and spread of clones in healthcare settings and around the world. The genomes of HA-MRSA isolates belonging to the same clonal group can show dramatic variability particularly in the carriage of mobile genetic elements (MGEs) encoding virulence and resistance genes. HA-MRSA are potentially resistant to all classes of antibiotics, although individual isolates that are fully drug resistant are not reported. The incidence of fluoroquinolone resistance in HA-MRSA is remarkably high, suggesting use of this class of antibiotics as well as the β-lactams contributes to the selection and success of HA-MRSA clones in the hospital setting. PMID:23499479

  13. Long-term persistence of MRSA in re-admitted patients

    PubMed Central

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

    2010-01-01

    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. PMID:20602144

  14. Advances in MRSA drug discovery: where are we and where do we need to be?

    PubMed Central

    Kurosu, Michio; Siricilla, Shajila; Mitachi, Katsuhiko

    2013-01-01

    Introduction Methicillin-resistant Staphylococcus aureus (MRSA) have been on the increase during the past decade, due to the steady growth of the elderly and immunocompromised patients, and the emergence of multi-drug-resistant (MDR) bacterial strains. Although, only a limited number of anti-MRSA drugs are available, a number of different combination antimicrobial drug regimens have been used to treat serious MRSA infections. Thus, addition of several new antistaphylococcal drugs into clinical practice should broaden therapeutic options. Because MRSA is one of the most common and problematic bacteria associated with increasing antimicrobial resistance, continuous efforts on discovery of lead compounds as well as development of alternative therapies and faster diagnostics to ensure effective antistaphylococcal therapy are required. Areas covered This article summarizes the FDA approved drugs to treat MRSA infections, the drugs in clinical trials, and the drug leads for MRSA and related Gram-positive bacterial infections. In addition, the mode of action of antistaphylococcal molecules and resistant mechanisms of some molecules are briefly discussed. Expert opinion The number of pipeline drugs presently undergoing clinical trials is not particularly encouraging. There are limited and rather expensive therapeutic options for the infections by MRSA in the critically ill. This review article provides an update on antistaphylococcal drugs in clinical trials and antibacterial molecules effective against Gram-positive bacteria including MRSA. The structural and biological information of antibacterials summarized here are very useful for designing drug leads to develop into new anti-MRSA drugs. PMID:23829425

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

    PubMed Central

    Jiménez, J. Natalia; Ocampo, Ana M.; Vanegas, Johanna M.; Rodriguez, Erika A.; Mediavilla, José R.; Chen, Liang; Muskus, Carlos E.; A. Vélez, Lázaro; Rojas, Carlos; Restrepo, Andrea V.; Ospina, Sigifredo; Garcés, Carlos; Franco, Liliana; Bifani, Pablo; Kreiswirth, Barry N.; Correa, Margarita M.

    2012-01-01

    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. PMID:22745670

  16. Eczema-Like Psoriasiform Skin Reaction due to Brazilian Keratin Treatment

    PubMed Central

    Gavazzoni-Dias, Maria Fernanda Reis; Rochael, Mayra; Vilar, Enoï; Tanus, Aline; Tosti, Antonella

    2016-01-01

    The use of formaldehyde and formaldehyde releasers in hair-straightening formulations started in Rio de Janeiro in 2003. The technique is known as BKT, Brazilian keratin treatment. The aim of this study was to analyze the types of skin reactions presented by patients due to BKT. We describe 7 patients with severe erythema and scurf on the scalp which developed shortly after BKT. The lesions were eczema-like psoriasiform, located mainly on the scalp. Some patients also developed eczema-like lesions and pustules on the face, neck, upper arms, and upper trunk. Dermatoscopic findings included erythema, perifollicular and interfollicular scurf. The peripilar desquamation resembled the outer skin of an onion bulb. Scalp biopsies revealed psoriasiform and spongiotic psoriasiform patterns, one of them similar to anti-TNFα biologic drug psoriasiform alopecia. The possible consequences of the absorption of formaldehyde by hairdressers or clients are still to be verified by the scientific community; however, the skin and scalp reactions observed in our cases suggest a drug reaction phenomenon and not only eczemas of irritant or allergic origin. PMID:27172059

  17. Impact of socioeconomic and environmental factors on atopic eczema and allergic rhinitis: a cross sectional study

    PubMed Central

    Torfi, Yasamin; Bitarafan, Niloofar; Rajabi, Mehdi

    2015-01-01

    The prevalence of allergic rhinitis and atopic eczema is on the rise in recent decades. Many factors can be related to the development of these diseases. We aimed to investigate the association between socioeconomic status (SES), environmental risk factors and these conditions. In this study, the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire was translated and validated. Then it was used to determine the prevalence, severity and possible related factors for both diseases in 1904 schoolchildren aged 6-7 and 13-14 years from various regions of Tehran. The prevalence of rhinitis and eczema in the past year was 33.2 % and 8.2 %, respectively. The prevalence of rhinoconjunctivitis in the past year was 30 %. The risk factors such as birth order, nursery attendance, pet ownership, past allergic experiences as well as some SES factors were associated with both conditions. The prevalence of allergic rhinitis and atopic eczema was on the rise in comparison to the previous studies and SES as well as environmental factors are thought to be associated with the prevalence of these conditions.

  18. A comparison of linezolid with glycopeptides in severe MRSA pneumonia.

    PubMed

    Abunasser, Jafar; Metersky, Mark L

    2009-10-01

    Evaluation of: Luna CM, Bruno DA, García-Morato J et al. Effect of linezolid compared with glycopeptides in methicillin-resistant Staphylococcus aureus severe pneumonia in piglets. Chest 135(6), 1564-1571 (2009). Methicillin-resistant Staphylococcus aureus (MRSA) has emerged as a major pathogen in nosocomial infections and accounts for a large proportion of nosocomial pneumonia. However, there are limited antibiotics available for the treatment of this serious and potentially lethal infection. Until recently, the only effective antibiotic was vancomycin, but the oxazolidinones, such as linezolid, have been shown to be a valuable addition to the arsenal of antimicrobial agents that can be used for MRSA pneumonia. Clinical trials have been conducted to compare vancomycin and linezolid head-to-head in pneumonia and, in post hoc subgroup analyses, showed that linezolid use was associated with improved survival. The ensuing debate over these results was dominated by two opinions; there were those who speculated on the mechanism by which linezolid achieved this benefit, namely attributing it to pharmacodynamics and pharmacokinetics, and others who criticized the methodology of the studies and questioned the validity of the results altogether. This study by Luna and colleagues was designed with several goals in mind. The first was to attempt to generate an animal model of MRSA pneumonia in piglets by duplicating techniques used in animal models of Gram-negative pneumonia. Then they studied the effect of three antibiotics (vancomycin, linezolid and teicoplanin) on outcomes in the same model, while simultaneously measuring antibiotic levels in the serum, bronchoalveolar lavage fluid and lung tissue, in an attempt to attribute differences in survival to pharmacological properties of the drugs used. Their results showed a survival benefit only for linezolid, despite the fact that all three antibiotics had levels above MIC in all the compartments sampled, leading them to speculate that linezolid may have improved outcomes by mechanisms not directly related to its antimicrobial actions. PMID:19803704

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

    PubMed Central

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

    2011-01-01

    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 μg/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. PMID:21293147

  20. Meticillin-resistant Staphylococcus aureus (MRSA): global epidemiology and harmonisation of typing methods.

    PubMed

    Stefani, Stefania; Chung, Doo Ryeon; Lindsay, Jodi A; Friedrich, Alex W; Kearns, Angela M; Westh, Henrik; Mackenzie, Fiona M

    2012-04-01

    This article reviews recent findings on the global epidemiology of healthcare-acquired/associated (HA), community-acquired/associated (CA) and livestock-associated (LA) meticillin-resistant Staphylococcus aureus (MRSA) and aims to reach a consensus regarding the harmonisation of typing methods for MRSA. MRSA rates continue to increase rapidly in many regions and there is a dynamic spread of strains across the globe. HA-MRSA is currently endemic in hospitals in most regions. CA-MRSA clones have been spreading rapidly in the community and also infiltrating healthcare in many regions worldwide. To date, LA-MRSA is only prevalent in certain high-risk groups of workers in direct contact with live animals. CA-MRSA and LA-MRSA have become a challenge for countries that have so far maintained low rates of MRSA. These evolutionary changes have resulted in MRSA continuing to be a major threat to public health. Continuous efforts to understand the changing epidemiology of S. aureus infection in humans and animals are therefore necessary, not only for appropriate antimicrobial treatment and effective infection control but also to monitor the evolution of the species. The group made several consensus decisions with regard to harmonisation of typing methods. A stratified, three-level organisation of testing laboratories was proposed: local; regional; and national. The functions of, and testing methodology used by, each laboratory were defined. The group consensus was to recommend spa and staphylococcal cassette chromosome mec (SCCmec) typing as the preferred methods. Both are informative in defining particular strain characteristics and utilise standardised nomenclatures, making them applicable globally. Effective communication between each of the different levels and between national centres was viewed as being crucial to inform and monitor the molecular epidemiology of MRSA at national and international levels. PMID:22230333

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

    PubMed Central

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

    2011-01-01

    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 PMID:21358807

  2. MRSA care in the community: why patient education matters.

    PubMed

    Robinson, Jude; Edgley, Alison; Morrell, Jane

    2014-09-01

    In primary care, patients are prescribed decolonisation treatment to eradicate meticillin-resistant Staphylococcus aureus (MRSA). This complex treatment process requires the patient to apply a topical antimicrobial treatment as well as adhering to rigorous cleaning regimens to ensure the environment is effectively managed. A pilot study was carried out that involved developing an enhanced, nurse-delivered education tool, training a community nurse to use it, then testing its use with a patient. Three interviews were carried out: one with a patient who received usual care, one with a patient who received the enhanced education and one with the community nurse who delivered the enhanced education tool. The patient who received the enhanced education reported better knowledge and understanding of the application of treatment than the patient who did not. These results are interesting and point the way forward for larger research studies to build on the learning from this limited exploration and develop more effective management of MRSA in primary care. PMID:25184897

  3. MRSA--why treat the symptoms and not the disease?

    PubMed

    Spigelman, M

    2005-11-01

    The recent debate over MRSA in our community is really getting to the state of the ridiculous. There is no question that this bacterium, which has been around for at least 40 years, is becoming a bigger and bigger menace in hospitals. Prior to the election, the shadow health secretary, Andrew Lansley, claimed that hospitals are being told to push more patients through beds rather than concentrating on hygiene and this is the cause of the epidemic. He calls for a search and destroy strategy to clean up wards. The health secretary, Dr John Reid, blames the increased use of contract cleaners under the last Tory government for the rise in the rates of infection. This is supported by the Public Sector Trades Union. They believe that it is the high input of patients that prevents MRSA and other hospital-acquired infections being tackled effectively. The answer, they feel, is strict hospital hygiene and frequent hand washing, with a higher proportion of single rooms.Now, we are told that matrons should take charge of cleanliness in hospitals. Despite all the hand wringing and washing, the morbidity and mortality are both in an upward spiral. PMID:16263016

  4. Towards an Ontological Representation of Resistance: The Case of MRSa

    PubMed Central

    Goldfain, Albert; Smith, Barry; Cowell, Lindsay G.

    2010-01-01

    This paper addresses a family of issues surrounding the biological phenomenon of resistance and its representation in realist ontologies. The treatments of resistance terms in various existing ontologies are examined and found to be either overly narrow, internally inconsistent, or otherwise problematic. We propose a more coherent characterization of resistance in terms of what we shall call blocking dispositions, which are collections of mutually coordinated dispositions which are of such a sort that they cannot undergo simultaneous realization within a single bearer. A definition of ‘protective resistance’ is proposed for use in the Infectious Disease Ontology (IDO) and we show how this definition can be used to characterize the antibiotic resistance in Methicillin-Resistant Staphylococcus aureus (MRSa). The ontological relations between entities in our MRSa case study are used alongside a series of logical inference rules to illustrate logical reasoning about resistance. A description logic representation of blocking dispositions is also provided. We demonstrate that our characterization of resistance is sufficiently general to cover two other cases of resistance in the infectious disease domain involving HIV and malaria. PMID:20206294

  5. Extensive Dissemination of Methicillin-Resistant Staphylococcus aureus (MRSA) between the Hospital and the Community in a Country with a High Prevalence of Nosocomial MRSA

    PubMed Central

    Espadinha, Diana; Faria, Nuno A.; Miragaia, Maria; Lito, Luís Marques; Melo-Cristino, José; de Lencastre, Hermínia

    2013-01-01

    According to the EARS-Net surveillance data, Portugal has the highest prevalence of nosocomial methicillin-resistant Staphylococcus aureus (MRSA) in Europe, but the information on MRSA in the community is very scarce and the links between the hospital and community are not known. In this study we aimed to understand the events associated to the recent sharp increase in MRSA frequency in Portugal and to evaluate how this has shaped MRSA epidemiology in the community. With this purpose, 180 nosocomial MRSA isolates recovered from infection in two time periods and 14 MRSA isolates recovered from 89 samples of skin and soft tissue infections (SSTI) were analyzed by pulsed-field gel electrophoresis (PFGE), staphylococcal chromosome cassette mec (SCCmec) typing, spa typing and multilocus sequence typing (MLST). All isolates were also screened for the presence of Panton Valentine leukocidin (PVL) and arginine catabolic mobile element (ACME) by PCR. The results showed that ST22-IVh, accounting for 72% of the nosocomial isolates, was the major clone circulating in the hospital in 2010, having replaced two previous dominant clones in 1993, the Iberian (ST247-I) and Portuguese (ST239-III variant) clones. Moreover in 2010, three clones belonging to CC5 (ST105-II, ST125-IVc and ST5-IVc) accounted for 20% of the isolates and may represent the beginning of new waves of MRSA in this hospital. Interestingly, more than half of the MRSA isolates (8/14) causing SSTI in people attending healthcare centers in Portugal belonged to the most predominant clones found in the hospital, namely ST22-IVh (n = 4), ST5-IVc (n = 2) and ST105-II (n = 1). Other clones found included ST5-V (n = 6) and ST8-VI (n = 1). None of the MRSA isolates carried PVL and only five isolates (ST5-V-t179) carried ACME type II. The emergence and spread of EMRSA-15 may be associated to the observed increase in MRSA frequency in the hospital and the consequent spillover of MRSA into the community. PMID:23593155

  6. Transmission through air as a possible route of exposure for MRSA.

    PubMed

    Bos, Marian E H; Verstappen, Koen M; van Cleef, Brigitte A G L; Dohmen, Wietske; Dorado-García, Alejandro; Graveland, Haitske; Duim, Birgitta; Wagenaar, Jaap A; Kluytmans, Jan A J W; Heederik, Dick J J

    2016-05-01

    Livestock-associated methicillin-resistant Staphylococcus aureus (LA-MRSA) is highly prevalent in pigs and veal calves. The environment and air in pig and veal calf barns is often contaminated with LA-MRSA, and can act as a transmission source for humans. This study explores exposure-response relationships between sequence type 398 (ST398) MRSA air exposure level and nasal ST398 MRSA carriage in people working and/or living on farms. Samples and data were used from three longitudinal field studies in pig and veal calf farm populations. Samples consisted of nasal swabs from the human participants and electrostatic dust fall collectors capturing airborne settled dust in barns. In both multivariate and mutually adjusted analyses, a strong association was found between nasal ST398 MRSA carriage in people working in the barns for >20 h per week and MRSA air levels. In people working in the barns < 20 h per week there was a strong association between nasal carriage and number of working hours. Exposure to ST398 MRSA in barn air seems to be an important determinant for nasal carriage, especially in the highly exposed group of farmers, next to duration of contact with animals. Intervention measures should therefore probably also target reduction of ST398 MRSA air levels. PMID:25515375

  7. Fatal Septicemia Linked to Transmission of MRSA Clonal Complex 398 in Hospital and Nursing Home, Denmark.

    PubMed

    Nielsen, Rikke Thoft; Kemp, Michael; Holm, Anette; Skov, Marianne Nielsine; Detlefsen, Mette; Hasman, Henrik; Aarestrup, Frank Møller; Kaas, Rolf Sommer; Nielsen, Jesper Boye; Westh, Henrik; Kolmos, Hans Jørn

    2016-05-01

    We describe 2 fatal cases of methicillin-resistant Staphylococcus aureus (MRSA) clonal complex 398 septicemia in persons who had no contact with livestock. Whole-genome sequencing of the isolated MRSA strains strongly suggest that both were of animal origin and that the patients had been infected through 2 independent person-to-person transmission chains. PMID:27089007

  8. Fatal Septicemia Linked to Transmission of MRSA Clonal Complex 398 in Hospital and Nursing Home, Denmark

    PubMed Central

    Kemp, Michael; Holm, Anette; Skov, Marianne Nielsine; Detlefsen, Mette; Hasman, Henrik; Aarestrup, Frank Møller; Kaas, Rolf Sommer; Nielsen, Jesper Boye; Westh, Henrik; Kolmos, Hans Jørn

    2016-01-01

    We describe 2 fatal cases of methicillin-resistant Staphylococcus aureus (MRSA) clonal complex 398 septicemia in persons who had no contact with livestock. Whole-genome sequencing of the isolated MRSA strains strongly suggest that both were of animal origin and that the patients had been infected through 2 independent person-to-person transmission chains. PMID:27089007

  9. MRSA infection in patients hospitalized at Sanglah Hospital: a case series.

    PubMed

    Gayatri, A A Ayu Yuli; Utama, Susila; Somia, Agus; Merati, Tuti P

    2015-01-01

    This is the first report of MRSA infection in Sanglah Hospital. We reviewed eight patients with MRSA infection from microbiologi laboratory records between January and May 2011, than followed by tracing medical records to obtained data of the patients. Five of cases with sepsis, 1 case with osteomyelitis, and the two others with mediastinitis and pneumonia. The patients were kept in private isolated room and barrier-nursing technique was strictly followed. Further action was culturing specimen taken from the patients nose, throat, axilla, and samples taken from the health care workers, with no MRSA colonization were found. Five patients demonstrated good respond to intravenous administration of either vancomycin or linezolide. Three were died due to septic shock before the laboratory culture and antimicrobial susceptibility availabled. All of the strains isolated more than 48 hours after admission and also demonstrated clinical risk factors for hospitalized acquired MRSA (HA-MRSA). These strains had resistance to b-lactams but remain susceptible to many non b-lactam antibiotics, as reported in some community acquired MRSA (CA-MRSA) isolates. Future study using molecular typing required to fully understand the magnitude and ongoing evolution of MRSA infections. PMID:25948768

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

    PubMed Central

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

    2013-01-01

    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. PMID:23326505

  11. Transcriptional Events during the Recovery from MRSA Lung Infection: A Mouse Pneumonia Model

    PubMed Central

    Chen, Jiwang; Feng, Gang; Guo, Qiang; Wardenburg, Juliane B.; Lin, Simon; Inoshima, Ichiro; Deaton, Ryan; Yuan, Jason X. J.; Garcia, Joe G. N.; Machado, Roberto F.; Otto, Michael; Wunderink, Richard G.

    2013-01-01

    Community associated methicillin-resistant Staphylococcus aureus (CA-MRSA) is an emerging threat to human health throughout the world. Rodent MRSA pneumonia models mainly focus on the early innate immune responses to MRSA lung infection. However, the molecular pattern and mechanisms of recovery from MRSA lung infection are largely unknown. In this study, a sublethal mouse MRSA pneumonia model was employed to investigate late events during the recovery from MRSA lung infection. We compared lung bacterial clearance, bronchoalveolar lavage fluid (BALF) characterization, lung histology, lung cell proliferation, lung vascular permeability and lung gene expression profiling between days 1 and 3 post MRSA lung infection. Compared to day 1 post infection, bacterial colony counts, BALF total cell number and BALF protein concentration significantly decreased at day 3 post infection. Lung cDNA microarray analysis identified 47 significantly up-regulated and 35 down-regulated genes (p<0.01, 1.5 fold change [up and down]). The pattern of gene expression suggests that lung recovery is characterized by enhanced cell division, vascularization, wound healing and adjustment of host adaptive immune responses. Proliferation assay by PCNA staining further confirmed that at day 3 lungs have significantly higher cell proliferation than at day 1. Furthermore, at day 3 lungs displayed significantly lower levels of vascular permeability to albumin, compared to day 1. Collectively, this data helps us elucidate the molecular mechanisms of the recovery after MRSA lung infection. PMID:23936388

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

    PubMed Central

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

    2013-01-01

    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. PMID:24151444

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

    PubMed Central

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

    2014-01-01

    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

  14. Evaluation of the BD GeneOhm Methicillin-Resistant Staphylococcus aureus (MRSA) Assay as a Method for Detection of MRSA Isolates, Using a Large Collection of European and North African Isolates

    PubMed Central

    Bes, Michele; Meugnier, Helene; Tigaud, Sylvestre; Etienne, Jérôme; Vandenesch, François; Laurent, Frédéric

    2014-01-01

    Using a large collection of European and North African methicillin-resistant Staphylococcus aureus (MRSA) isolates with a variety of genetic backgrounds and staphylococcal cassette chromosome mec (SCCmec) types, we evaluated the reliability of the BD GeneOhm MRSA assay. Results revealed high performance of this test for detecting MRSA strains provided from Europe and North Africa (98.3%). PMID:25274997

  15. Necrotizing Fasciitis of Hand By Methicillin Resistant Staphylococcus aureus (MRSA) - A Sinister.

    PubMed

    Chauhan, Harendra; Patil, Saiprasad; Hajare, Anoop; Krishnaprasad, K; Bhargava, Amit

    2015-06-01

    Necrotizing fasciitis (NF) is an aggressive and life-threatening infection of skin and soft tissue characterized by widespread fascial necrosis, leads to gross morbidity and mortality if left untreated. Although MRSA has become a common isolate associated with skin and soft tissue infections globally over the past few years, monomicrobial MRSA NF has been reported only in a few studies. Our case represents the development of NF followed by trivial trauma salvaged with daptomycin and amputation of the affected limb. Prompt diagnosis and surgical management with empiric MRSA cover in areas where community acquired MRSA (CA-MRSA) is endemic for suspected cases of necrotizing fasciitis can prevent the dreaded consequences. PMID:26266121

  16. Skin care education and individual counselling versus treatment as usual in healthcare workers with hand eczema: randomised clinical trial

    PubMed Central

    Jemec, Gregor B E; Diepgen, Thomas L; Gluud, Christian; Lindschou Hansen, Jane; Winkel, Per; Thomsen, Simon Francis; Agner, Tove

    2012-01-01

    Objective To evaluate the effect of a secondary prevention programme with education on skin care and individual counselling versus treatment as usual in healthcare workers with hand eczema. Design Randomised, observer blinded parallel group superiority clinical trial. Setting Three hospitals in Denmark. Participants 255 healthcare workers with self reported hand eczema within the past year randomised centrally and stratified by profession, severity of eczema, and hospital. 123 were allocated to the intervention group and 132 to the control group. Interventions Education in skin care and individual counselling based on patch and prick testing and assessment of work and domestic related exposures. The control was treatment as usual. Main outcome measures The primary outcome was clinical severity of disease at five month follow-up measured by scores on the hand eczema severity index. The secondary outcomes were scores on the dermatology life quality index, self evaluated severity of hand eczema, skin protective behaviours, and knowledge of hand eczema from onset to follow-up. Results Follow-up data were available for 247 of 255 participants (97%). At follow-up, the mean score on the hand eczema severity index was significantly lower (improved) in the intervention group than control group: difference of means, unadjusted −3.56 (95% confidence interval −4.92 to −2.14); adjusted −3.47 (−4.80 to −2.14), both P<0.001 for difference. The mean score on the dermatology life quality index was also significantly lower (improved) in the intervention group at follow-up: difference of means: unadjusted −0.78, non-parametric test P=0.003; adjusted −0.92, −1.48 to −0.37). Self evaluated severity and skin protective behaviour by hand washings and wearing of protective gloves were also statistically significantly better in the intervention group, whereas this was not the case for knowledge of hand eczema. Conclusion A secondary prevention programme for hand eczema improved severity and quality of life and had a positive effect on self evaluated severity and skin protective behaviour by hand washings and wearing of protective gloves. Trial registration ClinicalTrials.gov NCT01012453. PMID:23236031

  17. IgE antibodies and urinary trimethylarsine oxide accounted for 1-7% population attributable risks for eczema in adults: USA NHANES 2005-2006.

    PubMed

    Shiue, Ivy

    2015-12-01

    Population attributable risks from serum IgE and dust miteallergen concentrations and environmental chemicals for eczema are unclear. Therefore, it was aimed to examine serum IgE and allergen concentrations and environmental chemicals for eczema in adults and to calculate population attributable risks in a national and population-based setting. Data retrieved from the National Health and Nutrition Examination Survey, 2005-2006, was analyzed. Information on demographics and self-reported ever eczema was obtained by household interview. Bloods and urines (sub-sample) were also collected during the interview. Adults aged 20-85 were included. Statistical analyses were using chi-square test, t test, survey-weighted logistic regression modeling, and population attributable risk (PAR) estimation. Of all the included American adults (n = 4979), 310 (6.2%) reported ever eczema. Moreover, more eczema cases were observed in female adults but fewer cases in people born in Mexico. There were no significant associations observed between commonly known biomarkers (including vitamin D) and eczema or between dust mite allergens and eczema. Serum D. Farinae (PAR 1.0%), D. Pteronyssinus (PAR 1.1%), cat (PAR 1.8%), dog (PAR 1.6%), and muse (PAR 3.2%) IgE antibodies were associated with eczema. Adults with ever eczema were found to have higher levels of urinary trimethylarsine oxide concentrations (PAR 7.0%) but not other speciated arsenic concentrations. There were no clear associations between other environmental chemicals including heavy metals, phthalates, phenols, parabens, pesticides, nitrate, perchlorate, polycyclic hydrocarbons and eczema as well. Elimination of environmental risks might help delay or stop eczema up to 7% in the adult population. PMID:26233738

  18. Methicillin-Resistant Staphylococcus aureus (MRSA) Detected at Four U.S. Wastewater Treatment Plants

    PubMed Central

    Goldstein, Rachel E. Rosenberg; Micallef, Shirley A.; Gibbs, Shawn G.; Davis, Johnnie A.; He, Xin; George, Ashish; Kleinfelter, Lara M.; Schreiber, Nicole A.; Mukherjee, Sampa; Joseph, Sam W.

    2012-01-01

    Background: The incidence of community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) infections is increasing in the United States, and it is possible that municipal wastewater could be a reservoir of this microorganism. To date, no U.S. studies have evaluated the occurrence of MRSA in wastewater. Objective: We examined the occurrence of MRSA and methicillin-susceptible S. aureus (MSSA) at U.S. wastewater treatment plants. Methods: We collected wastewater samples from two Mid-Atlantic and two Midwest wastewater treatment plants between October 2009 and October 2010. Samples were analyzed for MRSA and MSSA using membrane filtration. Isolates were confirmed using biochemical tests and PCR (polymerase chain reaction). Antimicrobial susceptibility testing was performed by Sensititre® microbroth dilution. Staphylococcal cassette chromosome mec (SCCmec) typing, Panton-Valentine leucocidin (PVL) screening, and pulsed field gel electrophoresis (PFGE) were performed to further characterize the strains. Data were analyzed by two-sample proportion tests and analysis of variance. Results: We detected MRSA (n = 240) and MSSA (n = 119) in 22 of 44 (50%) and 24 of 44 (55%) wastewater samples, respectively. The odds of samples being MRSA-positive decreased as treatment progressed: 10 of 12 (83%) influent samples were MRSA-positive, while only one of 12 (8%) effluent samples was MRSA-positive. Ninety-three percent and 29% of unique MRSA and MSSA isolates, respectively, were multidrug resistant. SCCmec types II and IV, the pvl gene, and USA types 100, 300, and 700 (PFGE strain types commonly found in the United States) were identified among the MRSA isolates. Conclusions: Our findings raise potential public health concerns for wastewater treatment plant workers and individuals exposed to reclaimed wastewater. Because of increasing use of reclaimed wastewater, further study is needed to evaluate the risk of exposure to antibiotic-resistant bacteria in treated wastewater. PMID:23124279

  19. Comparative Fitness and Determinants for the Characteristic Drug Resistance of ST239-MRSA-III-t030 and ST239-MRSA-III-t037 Strains Isolated in China.

    PubMed

    Shang, Weilong; Hu, Qiwen; Yuan, Wenchang; Cheng, Hang; Yang, Jie; Hu, Zhen; Yuan, Jizhen; Zhang, Xiaopeng; Peng, Huagang; Yang, Yancheng; Hu, Xiaomei; Li, Ming; Zhu, Junmin; Rao, Xiancai

    2016-04-01

    Sequence type (ST) 239 with SCCmec type III methicillin-resistant Staphylococcus aureus (ST239-MRSA-III) is the most predominant multidrug-resistant clone in China. The subclone ST239-MRSA-III-t037 has been gradually replaced with ST239-MRSA-III-t030 since 2000. Subclones are characterized by drug resistance profiles. However, the mechanisms of the clonal dynamics and determinants of distinct drug resistance remain poorly understood. In the present study, 12 ST239-MRSA-III-t030 and 12 ST239-MRSA-III-t037 strains were collected from Chongqing, Guangzhou, and Shanghai; these strains were selected and investigated in terms of t030/t037 strain pairs. Independent growth curve assay revealed that the ST239-MRSA-III-t030 strains grew more rapidly, with significantly shorter doubling times, than the ST239-MRSA-III-t037 strains (p < 0.001). The ST239-MRSA-III-t037 strains exhibited slightly to moderately higher (3-13%) fitness cost than the ST239-MRSA-III-t030 strains in a competition assay in vitro. The ST239-MRSA-III-t037 strains yielded lower bacterial loads in the kidneys of the infected mice than the ST239-MRSA-III-t030 rivals in a coinfection assay (p < 0.05). The ST239-MRSA-III-t030 strains were resistant to rifampicin but susceptible to trimethoprim/sulfamethoxazole (SXT). In contrast, the ST239-MRSA-III-t037 strains were susceptible to rifampicin but resistant to SXT. The genetic determinants of the resistance to rifampicin and SXT in the MRSA strains were determined. Our results suggest that the relatively low fitness cost and characteristic drug resistance phenotype can help explain the current predominance of these ST239-MRSA-III-t030 strains in Chinese hospitals. PMID:26565599

  20. Methicillin-resistant Staphylococcus aureus (MRSA) in slaughtered pigs and abattoir workers in Italy.

    PubMed

    Normanno, Giovanni; Dambrosio, Angela; Lorusso, Vanessa; Samoilis, Georgios; Di Taranto, Pietro; Parisi, Antonio

    2015-10-01

    Methicillin-resistant Staphylococcus aureus (MRSA) is a pathogen present in the hospital environment (HA-MRSA), in the community (CA-MRSA) and in livestock, including pigs (LA-MRSA). MRSA may enter the human food chain during slaughtering and may infect humans coming into direct contact with pigs or pork products. This study aimed to determine the prevalence and characteristics of MRSA isolated from pigs and workers at industrial abattoirs in southern Italy. A total of 215 pig nasal swabs were screened for the presence of MRSA using PCR. An MRSA isolate was detected from each mecA/nuc PCR-positive sample and characterized by spa-typing, Multi-Locus Sequence Typing, SCC-mec and Panton-Valentine Leukocidin (PVL), and also tested for the production of staphylococcal enterotoxins (SEs). Eighty-one MRSA isolates (37.6%) were obtained from the 215 pig nasal swabs; 37 of these isolates were further characterized, and showed 18 different spa-types and 8 different STs. The most frequently recovered STs were ST398 (CC398-t034, t011, t899, t1939 - 43.2%) followed by ST8 (CC8-t008, t064, t2953, t5270 - 24.3%) and ST1 (CC1-t127, t174, t2207 - 10.8%). Nine MRSA isolates were obtained from the 113 human swabs; the isolates showed 5 different spa-types and 5 different STs, including the novel ST2794 (t159). The most representative STs recovered were ST1 (CC1-t127) and ST398 (CC398-t034) (33.3%). None of the MRSA isolates showed the ability to produce SEs and PVL and all resulted resistant to two or more classes of antimicrobials. This study shows the great genetic diversity of MRSA strains in slaughtered pigs and in abattoir employees in Italy, and clearly demonstrates the need for improved hygiene standards to reduce the risk of occupational and food-borne infection linked to the handling/consumption of raw pork containing MRSA. PMID:26187827

  1. Successful treatment of refractory chronic hand eczema with calcipotriol/betamethasone ointment: A report of three cases

    PubMed Central

    YANG, MIN; CHANG, JIAN-MIN

    2015-01-01

    Chronic hand eczema (CHE) is a common skin disorder with frequent relapses, and its treatment comprises a challenge due to its uncertain etiology. In particular, certain cases of CHE exhibiting severe keratinization have a very poor response to various treatments. The Daivobet ointment, a complex product comprising calcipotriol and betamethasone, has been successfully used for the treatment of patients with plaque-type psoriasis for ~10 years; however, there are few reports on the effect of the ointment on other skin disorders of abnormal keratinization, such as eczema. The present study reported 3 cases of refractory hyperkeratotic eczema of the hand that did not respond to several treatments, but responded well to topical Daivobet treatment. PMID:26640577

  2. MRSA endocarditis of bovine Contegra valved conduit: a case report

    PubMed Central

    2009-01-01

    Background Different techniques are used for the right ventricular outflow tract reconstruction, including homo- or porcine xenografts, which have several limitations. Contegra, a bovine jugular vein graft, is an interesting alternative to overcome these limitations. It consists of a bovine jugular vein with a naturally integrated valve in it. Isolated pulmonary valve endocarditis is extremely rare. Case presentation We report the case of a 20 years old male patient with acute endocarditis of bovine Contegra valved conduit, four years after right ventricular outflow tract reconstruction and atrial septal defect correction, associated with acute glomerulonephritis, renal failure and severe anemia, secondary to methicillin-resistant Staphylococcus aureus infection (MRSA). Conclusion We present a complex patient with acute endocarditis of bovine Contegra valved conduit. We believe that the presentation of this case should encourage the researchers for the discussing of the implantation of this conduit and the prevention of endocarditis in these patients. PMID:19146664

  3. When sepsis persists: a review of MRSA bacteraemia salvage therapy.

    PubMed

    Kullar, Ravina; Sakoulas, George; Deresinski, Stan; van Hal, Sebastiaan J

    2016-03-01

    MRSA bacteraemia (MRSAB), including infective endocarditis, carries a high mortality rate, with up to 50% of patients failing initial therapy with vancomycin and requiring salvage therapy. Persistent MRSAB can be difficult to successfully eliminate, especially when source control is not possible due to an irremovable focus or the bacteraemia still persists despite surgical intervention. Although vancomycin and daptomycin are the only two antibiotics approved by the US FDA for the treatment of patients with MRSAB as monotherapy, the employment of novel strategies is required to effectively treat patients with persistent MRSAB and these may frequently involve combination drug therapy. Treatment strategies that are reviewed in this manuscript include vancomycin combined with a ?-lactam, daptomycin-based therapy, ceftaroline-based therapy, linezolid-based therapy, quinupristin/dalfopristin, telavancin, trimethoprim/sulfamethoxazole-based therapy and fosfomycin-based therapy. We recommend that combination antibiotic therapy be considered for use in MRSAB salvage treatment. PMID:26565015

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

    PubMed Central

    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

    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. PMID:16675336

  5. Outbreak of eczema and rhinitis in a group of office workers in Greenland

    PubMed Central

    Ebbehøj, Niels E.; Agner, Tove; Zimerson, Erik; Bruze, Magnus

    2015-01-01

    Introduction Disturbed indoor climate may in some cases be associated with illness. In the present paper, we report the results from a thorough investigation of office workers in Greenland, who developed skin and/or airway problems after moving into renewed offices. Material and methods In 2009 the office of the Bank of Greenland had a total renovation of the building, including new furniture and carpets. Symptoms developed within the first year after moving back into the renewed buildings. After removal of carpets in the building, symptoms significantly improved. Workers were examined in 2009 and re-examined in 2013, including clinical examination, patch test and when relevant also skin prick tests and histamine release test. Isothiazolinones and fumarates, both able to cause airway as well as skin symptoms, were isolated from carpets before testing, and included in the test series. Results In total, 32 out of 80 workers (40%) developed symptoms; 27 reported eczema, 20 rhinitis and 4 urticaria. Eczema was located on the hands and/or lower arms in 18 workers, on the face in 10 workers and on legs/trunk in 12 workers. After intervention in the office, 22 workers with eczema reported significant improvement, all cases of hand eczema cleared and 16 workers with rhinitis also improved. Positive patch tests to carpet extracts were found significantly more frequent in the worker cohort than in a control group comprising 47 dermatitis patients (p<0.001). Only few workers reacted with a positive response to skin prick test or in the HR test, no obvious pattern in reactions was found, and no conclusions can be made from these reactions. Conclusion The results indicate that the reported symptoms are related to exposures from the building after renovation in 2009. A specific triggering exposure could not be identified, although chemicals from the glued carpets are suspected. The study is an example of a work place investigation, and illustrates the diversity of symptoms and exposures involved in “Sick Building” cases. PMID:26140387

  6. Trichosporon cutaneum (Trichosporon asahii) infection mimicking hand eczema in a patient with leukemia.

    PubMed

    Nakagawa, T; Nakashima, K; Takaiwa, T; Negayama, K

    2000-05-01

    Trichosporon Cutaneum is a yeast-like fungus that causes white piedra and onychomycosis. Recently, it has also been recognized as an opportunistic pathogen in immunocompromised hosts. We describe a 64-year-old woman who developed a superficial Trichosporon infection mimicking hand eczema during chemotherapy for her chronic myelocytic leukemia. To our knowledge, no cases of superficial infection like this one have previously been reported. This case suggests that careful examination is required in diagnosing Trichosporon infection in immunocompromised hosts, because the infection can be invasive or unusual in appearance. PMID:10767708

  7. MRSA carrying mecC in captive mara

    PubMed Central

    Espinosa-Gongora, C.; Harrison, E. M.; Moodley, A.; Guardabassi, L.; Holmes, M. A.

    2015-01-01

    Objectives To characterize the staphylococcal cassette chromosome mec (SCCmec), virulence and antimicrobial susceptibility of Staphylococcus aureus ST130 isolated from mara (Dolichotis patagonum), a large rodent species native to South America and kept in captivity at Copenhagen Zoo. Methods The presence of mecC was confirmed by PCR in 15 S. aureus ST130 isolated from mara during a previous study. WGS was performed on two randomly selected isolates to characterize their genomes with respect to SCCmec, virulence and resistance gene content. Antimicrobial susceptibility was tested using commercial broth microdilution tests. Results All the isolates belonged to spa type t528 ST130 and carried mecC. Based on WGS, mecC was 100% identical to the prototype sequence of S. aureus strain LGA251. The sequence of SCCmec type XI in the mara isolates had 23 SNPs compared with the one described in LGA251. The two sequenced strains harboured a set of virulence factors and other genomic features previously observed in ST130. Both strains carried norA as the only putative antimicrobial resistance gene in addition to mecC. Conclusions Our findings support the notion that a genetically conserved mecC-carrying MRSA ST130 clone is widespread in a variety of unrelated hosts in Denmark. Since the mara at Copenhagen Zoo have limited contact with humans and other animal species, it remains unclear whether mara are natural hosts of ST130 or acquired this lineage from unknown sources. The broad host range of MRSA ST130 supports its designation as a generalist lineage. PMID:25722301

  8. Public engagement with emerging infectious disease: the case of MRSA in Britain.

    PubMed

    Joffe, Hélène; Washer, Peter; Solberg, Christian

    2011-06-01

    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 been neglected due to management culture having superseded the matron culture that dominated the putative golden age of the NHS. Furthermore, MRSA represents a transgression of the purpose of a hospital as a clean and curative institution. While this widely shared picture is accompanied by a strong sense of general concern, the respondents associate contracting MRSA with other identities, such as hospitalised, young and old people. These associations are linked to feelings of personal invulnerability. There is also blame of foreigners--especially cleaners and nurses--for MRSA's spread. Thus, the data corroborate a key pattern of response found in relation to myriad EID--that of othering. However, the identities associated with contracting MRSA are mutable; therefore, the threat cannot be distanced unequivocally. Beyond developing an understanding of the relationship between epidemics and identities, this article proposes a fitting theory with which to explore EID-related public thinking. PMID:21347975

  9. PEGylated liposomal vancomycin: a glimmer of hope for improving treatment outcomes in MRSA pneumonia.

    PubMed

    Pumerantz, Andrew S

    2012-12-01

    Methicillin-resistant Staphylococcus aureus (MRSA) plays a significant role in the pandemic of multidrug resistant bacterial infections and is a major cause of hospital-acquired pneumonia. MRSA pneumonia carries a high morbidity and mortality rate especially in elderly diabetics with chronic kidney disease. S. aureus is highly virulent and successful respiratory pathogen. Vancomycin and linezolid are the only two antimicrobial agents FDA-approved to treat MRSA pneumonia. Standard vancomycin dosing is associated with high clinical failure rates and higher dosages are associated with increased nephrotoxicity. Pharmacokinetic and pharmacodynamic limitations are major contributors to poor outcomes with vancomycin. New agents are needed to improve treatment outcomes with MRSA pneumonia. Recently released antimicrobials with in vitro activity are not FDA-approved for treating MRSA pneumonia. Other novel agents are being investigated though none are in late-stage development. Pharmaceutical industry perception of low returns on investment, a Sisyphean regulatory environment, and obstacles to patentability have contributed to declining interest in both the development of novel antibiotics and the improvement of existing generic formulations. Despite decades of investigation into liposomal encapsulation as a drug delivery system that would increase efficacy and decrease toxicity, only liposomal amphotericin B and doxorubicin are commercially available. In this article, the pharmacokinetics and biodistribution of a novel PEGylated liposomal vancomycin formulation along with passive targeting and the enhanced permeability and retention effect of liposomal drug delivery; the pathogenesis of MRSA pneumonia; and recent patents of novel anti-MRSA agents, including inhalational liposomal vancomycin, are reviewed. PMID:22742394

  10. Methicillin resistant Staphylococcus aureus (MRSA) carriage in different free-living wild animal species in Spain.

    PubMed

    Porrero, M Concepcin; Mentaberre, Gregorio; Snchez, Sergio; Fernndez-Llario, Pedro; Gmez-Barrero, Susana; Navarro-Gonzalez, Nora; Serrano, Emmanuel; Casas-Daz, Encarna; Marco, Ignasi; Fernndez-Garayzabal, Jos-Francisco; Mateos, Ana; Vidal, Dolors; Lavn, Santiago; Domnguez, Lucas

    2013-10-01

    Methicillin-resistant Staphylococcus aureus (MRSA) is a life-threatening pathogen in humans and its presence in animals is a public health concern. The aim of this study was to measure the prevalence of MRSA in free-living wild animals. Samples from red deer (n=273), Iberian ibex (n=212), Eurasian Griffon vulture (n=40) and wild boar (n=817) taken from different areas in Spain between June 2008 and November 2011 were analyzed. Characterization of the isolates was performed by spa typing, multi-locus sequence typing (MLST) and antimicrobial susceptibility testing. A low prevalence of MRSA was found with 13 isolates obtained from 12 animals (0.89%; 95% CI: 0.46-1.56). All MRSA sequence types belonged to ST398 (t011 and t1451) and ST1 (t127). Genotypes and antimicrobial susceptibility patterns (tetracycline resistance in ST398 and clindamycin-erythromycin-tetracycline resistance in ST1) suggest that the MRSA found probably originated in livestock (ST398) or humans (ST1). This is the first report of MRSA carriers in free-living wild animals in Europe. Although our data showed that MRSA prevalence is currently low, free-living wild animals might act as reservoir and represent a potential risk for human health. PMID:23846031

  11. The Efficiency of Biofilters at Mitigating Airborne MRSA from a Swine Nursery.

    PubMed

    Ferguson, D D; Smith, T C; Donham, K J; Hoff, S J

    2015-10-01

    Our prior studies have been in agreement with other researchers in detecting airborne methicillin-resistant Staphylococcus aureus (MRSA) inside and downwind of a swine housing facility. MRSA emitted in the exhaust air of swine facilities creates a potential risk of transmission of these organisms to people in the general area of these facilities as well as to other animals. This study investigated a possible means of reducing those risks. We investigated the efficiency of biofilters to remove MRSA from the exhaust air of a swine building. Two types of biofilter media (hardwood chips and western red cedar shredded bark) were evaluated. Efficiency was measured by assessing both viable MRSA (viable cascade impactor) and dust particles (optical particle courter) in the pre-filtered and post-filtered air of a functioning swine production facility. Our study revealed that hardwood chips were respectively 92% and 88% efficient in removing viable MRSA and total dust particles. Western red cedar was 95% efficient in removing viable MRSA and 86% efficient in removing dust particles. Our findings suggest that biofilters can be used as effective engineering controls to mitigate the transmission of aerosolized MRSA in the exhaust air of enclosed swine housing facilities. PMID:26710579

  12. Synergistic, collaterally sensitive β-lactam combinations suppress resistance in MRSA

    PubMed Central

    Gonzales, Patrick R.; Pesesky, Mitchell W.; Bouley, Renee; Ballard, Anna; Biddy, Brent A.; Suckow, Mark A.; Wolter, William R.; Schroeder, Valerie A.; Burnham, Carey-Ann D.; Mobashery, Shahriar; Chang, Mayland; Dantas, Gautam

    2015-01-01

    Methicillin-resistant Staphylococcus aureus (MRSA) is one of the most prevalent multidrug-resistant pathogens worldwide, exhibiting increasing resistance to the latest antibiotic therapies. Here we show that the triple β-lactam combination meropenem/piperacillin/tazobactam (ME/PI/TZ) acts synergistically and is bactericidal against MRSA N315 and 72 clinical MRSA isolates in vitro, and clears MRSA N315 infection in a mouse model. ME/PI/TZ suppresses evolution of resistance in MRSA via reciprocal collateral sensitivity of its constituents. We demonstrate that these activities also extend to other carbapenem/penicillin/β-lactamase inhibitor combinations. ME/PI/TZ circumvents the tight regulation of the mec and bla operons in MRSA, the basis for inducible resistance to β-lactam antibiotics. Furthermore, ME/PI/TZ subverts the function of penicillin-binding protein 2a (PBP2a) action via allostery, which we propose as the mechanism for both synergy and collateral sensitivity. Showing similar in vivo activity to linezolid, ME/PI/TZ demonstrates that combinations of older β-lactam antibiotics could be effective against MRSA infections in humans. PMID:26368589

  13. Synergistic, collaterally sensitive β-lactam combinations suppress resistance in MRSA.

    PubMed

    Gonzales, Patrick R; Pesesky, Mitchell W; Bouley, Renee; Ballard, Anna; Biddy, Brent A; Suckow, Mark A; Wolter, William R; Schroeder, Valerie A; Burnham, Carey-Ann D; Mobashery, Shahriar; Chang, Mayland; Dantas, Gautam

    2015-11-01

    Methicillin-resistant Staphylococcus aureus (MRSA) is one of the most prevalent multidrug-resistant pathogens worldwide, exhibiting increasing resistance to the latest antibiotic therapies. Here we show that the triple β-lactam combination meropenem-piperacillin-tazobactam (ME/PI/TZ) acts synergistically and is bactericidal against MRSA subspecies N315 and 72 other clinical MRSA isolates in vitro and clears MRSA N315 infection in a mouse model. ME/PI/TZ suppresses evolution of resistance in MRSA via reciprocal collateral sensitivity of its constituents. We demonstrate that these activities also extend to other carbapenem-penicillin-β-lactamase inhibitor combinations. ME/PI/TZ circumvents the tight regulation of the mec and bla operons in MRSA, the basis for inducible resistance to β-lactam antibiotics. Furthermore, ME/PI/TZ subverts the function of penicillin-binding protein-2a (PBP2a) via allostery, which we propose as the mechanism for both synergy and collateral sensitivity. Showing in vivo activity similar to that of linezolid, ME/PI/TZ demonstrates that combinations of older β-lactam antibiotics could be effective against MRSA infections in humans. PMID:26368589

  14. Dose-response relationship between antimicrobial drugs and livestock-associated MRSA in pig farming.

    PubMed

    Dorado-García, Alejandro; Dohmen, Wietske; Bos, Marian E H; Verstappen, Koen M; Houben, Manon; Wagenaar, Jaap A; Heederik, Dick J J

    2015-06-01

    The farming community can be a vehicle for introduction of livestock-associated methicillin-resistant Staphylococcus aureus (LA-MRSA) in hospitals. During 2011-2013, an 18-month longitudinal study aimed at reducing the prevalence of LA-MRSA was conducted on 36 pig farms in the Netherlands. Evaluations every 6 months showed a slight decrease in MRSA prevalence in animals and a stable prevalence in farmers and family members. Antimicrobial use, expressed as defined daily dosages per animal per year, decreased 44% during the study period and was associated with declining MRSA prevalence in pigs. MRSA carriage in animals was substantially higher at farms using cephalosporins. Antimicrobial use remained strongly associated with LA-MRSA in humans regardless of the level of animal contact. A risk factor analysis outlined potential future interventions for LA-MRSA control. These results should encourage animal and public health authorities to maintain their efforts in reducing antimicrobial use in livestock and ask for future controlled intervention studies. PMID:25989456

  15. Dose-Response Relationship between Antimicrobial Drugs and Livestock-Associated MRSA in Pig Farming1

    PubMed Central

    Dohmen, Wietske; Bos, Marian E.H.; Verstappen, Koen M.; Houben, Manon; Wagenaar, Jaap A.; Heederik, Dick J.J.

    2015-01-01

    The farming community can be a vehicle for introduction of livestock-associated methicillin-resistant Staphylococcus aureus (LA-MRSA) in hospitals. During 2011–2013, an 18-month longitudinal study aimed at reducing the prevalence of LA-MRSA was conducted on 36 pig farms in the Netherlands. Evaluations every 6 months showed a slight decrease in MRSA prevalence in animals and a stable prevalence in farmers and family members. Antimicrobial use, expressed as defined daily dosages per animal per year, decreased 44% during the study period and was associated with declining MRSA prevalence in pigs. MRSA carriage in animals was substantially higher at farms using cephalosporins. Antimicrobial use remained strongly associated with LA-MRSA in humans regardless of the level of animal contact. A risk factor analysis outlined potential future interventions for LA-MRSA control. These results should encourage animal and public health authorities to maintain their efforts in reducing antimicrobial use in livestock and ask for future controlled intervention studies. PMID:25989456

  16. A national survey of skin infections, care behaviors and MRSA knowledge in the United States.

    PubMed

    Wilder, Jocelyn R; Wegener, Duane T; David, Michael Z; Macal, Charles; Daum, Robert; Lauderdale, Diane S

    2014-01-01

    A nationally representative sample of approximately 2000 individuals was surveyed to assess SSTI infections over their lifetime and then prospectively over six-months. Knowledge of MRSA, future likelihood to self-treat a SSTI and self-care behaviors was also queried. Chi square tests, linear and multinomial regression were used for analysis. About 50% of those with a reported history of a SSTI typical of MRSA had sought medical treatment. MRSA knowledge was low: 28% of respondents could describe MRSA. Use of protective self-care behaviors that may reduce transmission, such as covering a lesion, differed with knowledge of MRSA and socio-demographics. Those reporting a history of a MRSA-like SSTI were more likely to respond that they would self-treat than those without such a history (OR 2.05 95% CI 1.40, 3.01; p<0.001). Since half of respondents reported not seeking care for past lesions, incidence determined from clinical encounters would greatly underestimate true incidence. MRSA knowledge was not associated with seeking medical care, but was associated with self-care practices that may decrease transmission. PMID:25137061

  17. A National Survey of Skin Infections, Care Behaviors and MRSA Knowledge in the United States

    PubMed Central

    Wilder, Jocelyn R.; Wegener, Duane T.; David, Michael Z.; Macal, Charles; Daum, Robert; Lauderdale, Diane S.

    2014-01-01

    A nationally representative sample of approximately 2000 individuals was surveyed to assess SSTI infections over their lifetime and then prospectively over six-months. Knowledge of MRSA, future likelihood to self-treat a SSTI and self-care behaviors was also queried. Chi square tests, linear and multinomial regression were used for analysis. About 50% of those with a reported history of a SSTI typical of MRSA had sought medical treatment. MRSA knowledge was low: 28% of respondents could describe MRSA. Use of protective self-care behaviors that may reduce transmission, such as covering a lesion, differed with knowledge of MRSA and socio-demographics. Those reporting a history of a MRSA-like SSTI were more likely to respond that they would self-treat than those without such a history (OR 2.05 95% CI 1.40, 3.01; p<0.001). Since half of respondents reported not seeking care for past lesions, incidence determined from clinical encounters would greatly underestimate true incidence. MRSA knowledge was not associated with seeking medical care, but was associated with self-care practices that may decrease transmission. PMID:25137061

  18. Antimicrobial treatment of nosocomial meticillin-resistant Staphylococcus aureus (MRSA) pneumonia: current and future options.

    PubMed

    Welte, Tobias; Pletz, Mathias W

    2010-11-01

    Meticillin-resistant Staphylococcus aureus (MRSA) is a frequent cause of nosocomial pneumonia. Inadequate or inappropriate antimicrobial therapy, often caused by antimicrobial resistance, is associated with increased mortality for these infections. Agents currently recommended for the treatment of MRSA pneumonia include vancomycin and linezolid in the USA, and vancomycin, linezolid, teicoplanin and quinupristin/dalfopristin in Europe. Antimicrobials such as tigecycline and daptomycin, although approved for the treatment of some MRSA infections, have not demonstrated efficacy equivalent to the approved agents for MRSA pneumonia. Further agents lack data from randomised controlled trials (e.g. fosfomycin, fusidic acid or rifampicin in combination with vancomycin). Antimicrobial agents that have recently been approved or are being investigated as treatments for MRSA infections include the lipoglycopeptides telavancin (approved for the treatment of complicated skin and skin-structure infections in the USA and Canada), dalbavancin and oritavancin, the cephalosporins ceftobiprole and ceftaroline, and the dihydrofolate reductase inhibitor iclaprim. To be an effective treatment for MRSA pneumonia, antimicrobial agents must have activity against antimicrobial-resistant S. aureus, penetrate well into the lung, have a low potential for resistance development and have a good safety profile. Here, the available data for current and potential future MRSA pneumonia antimicrobials are reviewed and discussed. PMID:20724119

  19. A randomised placebo-controlled trial of oral and topical antibiotics for children with clinically infected eczema in the community: the ChildRen with Eczema, Antibiotic Management (CREAM) study.

    PubMed Central

    Francis, Nick A; Ridd, Matthew J; Thomas-Jones, Emma; Shepherd, Victoria; Butler, Christopher C; Hood, Kerenza; Huang, Chao; Addison, Katy; Longo, Mirella; Marwick, Charis; Wootton, Mandy; Howe, Robin; Roberts, Amanda; Haq, Mohammed Inaam-Ul; Madhok, Vishnu; Sullivan, Frank

    2016-01-01

    BACKGROUND Secondary skin infection is common during eczema exacerbations and many children are treated with antibiotics when this is suspected, although there is little high-quality evidence to justify this practice. OBJECTIVE To determine the clinical effectiveness of oral and topical antibiotics, in addition to standard treatment with emollients and topical corticosteroids, in children with clinically infected eczema. DESIGN Multicentre randomised, double-blind, placebo-controlled trial. SETTING General practices and dermatology clinics in England, Wales and Scotland. PARTICIPANTS Children (aged 3 months to < 8 years) with a diagnosis of eczema (according to U.K. Working Party definition) and clinical suspicion of infection. INTERVENTIONS (1) Oral flucloxacillin and topical placebo; (2) topical fusidic acid (Fucidin(®), Leo Laboratories Limited) and oral placebo; and (3) oral and topical placebos, all for 1 week. MAIN OUTCOME MEASURES Patient-Orientated Eczema Measure (POEM) at 2 weeks (assessing subjective severity in the week following treatment). RESULTS We randomised 113 children (36 to oral antibiotic, 37 to topical antibiotic and 40 to placebo), which was fewer than our revised target sample size of 282. A total of 103 (92.0%) children had one or more clinical features suggestive of infection and 78 (69.6%) children had Staphylococcus aureus cultured from a skin swab. Oral and topical antibiotics resulted in a 1.52 [95% confidence interval (CI) -1.35 to 4.40] and 1.49 (95% CI -1.55 to 4.53) increase (worse subjective severity) in POEM score at 2 weeks, relative to placebo and controlling for baseline POEM score. Eczema Area and Severity Index (objective severity) scores were also higher (worse) in the intervention groups, at 0.20 (95% CI -0.12 to 0.52) and 0.42 (95% CI 0.09 to 0.75) for oral and topical antibiotics, respectively, at 2 weeks. Analyses of impact on the family, quality of life, daily symptom scores, and longer-term outcomes were all consistent with the finding of no or limited difference and a trend towards worse outcomes in the intervention groups. Sensitivity analyses, including adjusting for compliance and imputation for missing data, were consistent with the main findings. CONCLUSIONS Our data suggest that oral and topical antibiotics have no effect, or a harmful effect, on subjective eczema severity in children with clinically infected eczema in the community. The CIs around our estimates exclude a meaningful beneficial effect (published minimal clinically important difference for POEM is 3.4). Although most patients in this trial had features suggestive of infection and S. aureus on their skin, participants primarily had mild-moderate eczema and those with signs of more severe infection were often excluded. Clinicians should consider avoiding oral and topical antibiotic use in children with suspected infected eczema in the community who do not have signs of 'severe infection'. Further research should seek to understand how best to encourage the use of topical steroids and limit use of antibiotics in those with eczema flares without signs of severe infection, as well as developing tools to better phenotype eczema flares, in order to better define a population that may benefit from antibiotic treatment. TRIAL REGISTRATION European Union Drug Regulating Authorities Clinical Trials (EudraCT) number 2011-003591-37 and Current Controlled Trials ISRCTN96705420. FUNDING The National Institute for Health Research Health Technology Assessment programme. PMID:26938214

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

    PubMed

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

    2009-02-01

    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

  1. [Methicillin-resistant Staphylococcus aureus (MRSA) in veterinary medicine: a "new emerging pathogen"?].

    PubMed

    Walther, Birgit; Friedrich, Alexander W; Brunnberg, Leo; Wieler, Lothar H; Lübke-Becker, Antina

    2006-01-01

    The problem of nosocomial infections is of increasing importance in veterinary medicine. As an example, this review summarizes current knowledge regarding methicillin-resistant Staphylococcus aureus (MRSA) as a typical example, as these pathogens are the most important agents of nosocomial infections in human medicine worldwide and are being increasingly reported in veterinary medicine. MRSA are classified by their ability to be resistant against oxacillin/methicillin, this feature being confered by mecA, a gene which was acquired by horizontal gene transfer of the staphylococcal gene cassette (SCCmec). It is this genetic information that enables MRSA to be resistant against all penicillins, cehalosporins and carbapenems. In addition, MRSA are often resistant against a variety of other antiinfectives, i.e. aminoglycosides, macrolides, lincosamide, streptomycins, tetracyclin, chloramphenicol, but also against fluorquinolones and rifampicin. Presumably, these highly adapted strains are particularly able to acquire resistance genes located on plasmids or transposons. They are also able to develop point mutations, further leading to resistant phenotypes. If these pathogens are leading to infectious diseases, veterinarians may be confronted with a worst-case scenario, being left without any antiinfective therapeutic. As Staphylococcus aureus is highly tenacid, professional hygiene management is of utmost importance. The increasing number of published sporadic MRSA infections, MRSA-infectious diseases as well as MRSA outbreaks in veterinary medicine justifies their recognition as a "New Emerging Pathogen". So far, horses and dogs are mostly affected by MRSA. Although transmission between humans and animals has been reported occasionally, the sources, routes of transmission or the epidemiological relevance of MRSA infections in animals are far from being understood. Therefore, epidemiological investigations utilizing molecular typing tools are mandatory. Typing tools like multilocus-sequence-typing (MLST), pulsefield-gelelectrophoresis (PFGE), sequence analysis of the gene encoding protein A (spa-typing) as well as SCCmec-typing are all at hand. PMID:16729469

  2. Longitudinal study on transmission of MRSA CC398 within pig herds

    PubMed Central

    2012-01-01

    Background Since the detection of MRSA CC398 in pigs in 2004, it has emerged in livestock worldwide. MRSA CC398 has been found in people in contact with livestock and thus has become a public health issue. Data from a large-scale longitudinal study in two Danish and four Dutch pig herds were used to quantify MRSA CC398 transmission rates within pig herds and to identify factors affecting transmission between pigs. Results Sows and their offspring were sampled at varying intervals during a production cycle. Overall MRSA prevalence of sows increased from 33% before farrowing to 77% before weaning. Overall MRSA prevalence of piglets was > 60% during the entire study period. The recurrent finding of MRSA in the majority of individuals indicates true colonization or might be the result of contamination. Transmission rates were estimated using a Susceptible-Infectious-Susceptible (SIS-)model, which resulted in values of the reproduction ratio (R0) varying from 0.24 to 8.08. Transmission rates were higher in pigs treated with tetracyclins and β-lactams compared to untreated pigs implying a selective advantage of MRSA CC398 when these antimicrobials are used. Furthermore, transmission rates were higher in pre-weaning pigs compared to post-weaning pigs which might be explained by an age-related susceptibility or the presence of the sow as a primary source of MRSA CC398. Finally, transmission rates increased with the relative increase of the infection pressure within the pen compared to the total infection pressure, implying that within-pen transmission is a more important route compared to between-pen transmission and transmission through environmental exposure. Conclusion Our results indicate that MRSA CC398 is able to spread and persist in pig herds, resulting in an endemic situation. Transmission rates are affected by the use of selective antimicrobials and by the age of pigs. PMID:22607475

  3. MRSA carriage in the equine community: an investigation of horse-caretaker couples.

    PubMed

    Van den Eede, A; Martens, A; Floré, K; Denis, O; Gasthuys, F; Haesebrouck, F; Van den Abeele, A; Hermans, K

    2013-05-01

    Equine methicillin-resistant Staphylococcus aureus (MRSA) carriage entails a risk of both equine and zoonotic transmission and infection. In Europe, CC398, the livestock-associated (LA-)MRSA is highly prevalent in horses and veterinary personnel at equine clinics. The extent of the MRSA reservoir created by healthy horses from the general population and associated health hazard for their daily caretakers is, however, unknown. This study aimed at screening healthy horse-caretaker couples from a broad range of home farms. At five equine gatherings, 166 couples were selected for MRSA screening in the anterior nares and participation in an epidemiologic survey. All MRSA isolates were subjected to genotyping and antimicrobial susceptibility testing. Only 4 humans (2.4%) and 2 of their horses (1.2%) tested MRSA positive. Within the 2 couples where both partners were positive, man and horse carried isolates belonging to identical, livestock-associated spa types (t011 and t2330) and demonstrating equal antimicrobial susceptibility patterns. For all LA-MRSA positive humans (n=3) and animals (n=2) regular (in)direct contact with the veterinary sector was reported. A significant association between the horses' carriage status and transportation to an event could not be demonstrated (P=1.00). In conclusion, outside equine clinics, the extent of the MRSA reservoir in horses and their caretakers was low. Travel to an equine gathering could not be withheld as a risk factor for equine MRSA carriage, whereas indications were found that contact with veterinary care may predispose both healthy horses and their handlers to carriage. PMID:23434186

  4. Risk factors for MRSA in fattening pig herds - a meta-analysis using pooled data.

    PubMed

    Fromm, Sabine; Beißwanger, Elena; Käsbohrer, Annemarie; Tenhagen, Bernd-Alois

    2014-11-01

    The importance of livestock-associated methicillin-resistant Staphylococcus aureus (LA-MRSA) as an infectious agent for humans has increased in recent years in Germany. Although it is well known that the prevalence of MRSA in pig farms is high, risk factors for the presence of MRSA in herds of fattening pigs are still poorly understood. The aim of this study was to evaluate available data from previous studies on MRSA in fattening pigs in a meta-analysis to answer the question: What are the factors associated with the occurrence of MRSA in fattening pig herds? The studies on MRSA in pigs that were identified by literature research were heterogeneous with respect to the risk factors investigated and the type of herds focused on. Therefore we decided to carry out a pooling analysis on herd level rather than a typical meta-analysis. Eligible herd data were identified based on the published literature and communication with the authors. The final data set covered 400 fattening pig herds from 10 different studies and 12 risk factors. The prevalence of MRSA in the 400 fattening pig herds was 53.5%. Data were analyzed using generalized estimating equations (GEE). The resulting multivariate model confirmed previously identified risk factors for MRSA in pig herds (herd size and herd type). It also identified further risk factors: group treatment of fattening pigs with antimicrobial drugs (OR=1.79) and housing fattening pig herds on at least partially slatted floors (OR=2.39) compared to plain floor. In contrast, according to the model, fattening pig herds on farms keeping other livestock along with pigs were less likely to harbor MRSA (OR=0.54). The results underline the benefits from a pooling analysis and cooperative re-evaluation of published data. PMID:25241618

  5. Cost-effectiveness of strategies to prevent MRSA transmission and infection in an intensive care unit

    PubMed Central

    Gidengil, Courtney; Gay, Charlene; Huang, Susan S; Platt, Richard; Yokoe, Deborah; Lee, Grace M.

    2014-01-01

    Objective We created a national policy model to evaluate the projected cost-effectiveness of multiple hospital-based strategies to prevent MRSA transmission and infection. Design Cost-effectiveness analysis using a Markov microsimulation model that simulates the natural history of MRSA acquisition and infection. Patients and setting Hypothetical cohort of 10,000 adult patients admitted to a U.S. ICU. Methods We compared 7 strategies to standard precautions using a hospital perspective: (1) active surveillance cultures (ASC); (2) ASC plus selective decolonization; (3) universal contact precautions (UCP); (4) universal chlorhexidine gluconate (CHG) baths; (5) universal decolonization; (6) UCP + CHG baths; and (7) UCP + decolonization. For each strategy, both efficacy and compliance were considered. Outcomes of interest were: (1) MRSA colonization averted; (2) MRSA infection averted; (3) incremental cost per colonization averted; (4) incremental cost per infection averted. Results 1,989 cases of colonization and 544 MRSA invasive infections occurred under standard precautions per 10,000 patients. Universal decolonization was the least expensive strategy and was more effective compared to all strategies except UCP + decolonization and UCP + CHG. UCP + decolonization was more effective than universal decolonization, but would cost $2,469 per colonization averted and $9,007 per infection averted. If MRSA colonization prevalence drops from 12% to 5%, ASC plus selective decolonization becomes the least expensive strategy. Conclusions Universal decolonization is cost-saving, preventing 44% of cases of MRSA colonization and 45% of cases of MRSA infection. Our model provides useful guidance for decision makers choosing between multiple available hospital-based strategies to prevent MRSA transmission. PMID:25627757

  6. Reduction in MRSA environmental contamination with a portable HEPA-filtration unit.

    PubMed

    Boswell, T C; Fox, P C

    2006-05-01

    There is renewed interest in the hospital environment as a potentially important factor for cross-infection with methicillin-resistant Staphylococcus aureus (MRSA) and other nosocomial pathogens. The aim of this study was to evaluate the effectiveness of a portable high-efficiency particulate air (HEPA)-filtration unit (IQAir Cleanroom H13, Incen AG, Goldach, Switzerland) at reducing MRSA environmental surface contamination within a clinical setting. The MRSA contamination rate on horizontal surfaces was assessed with agar settle plates in ward side-rooms of three patients who were heavy MRSA dispersers. Contamination rates were measured at different air filtration rates (60-235 m(3)/h) and compared with no air filtration using Poisson regression. Without air filtration, between 80% and 100% of settle plates were positive for MRSA, with the mean number of MRSA colony-forming units (cfu)/10-h exposure/plate ranging from 4.1 to 27.7. Air filtration at a rate of 140 m(3)/h (one patient) and 235 m(3)/h (two patients), resulted in a highly significant decrease in contamination rates compared with no air filtration (adjusted rate ratios 0.037, 0.099 and 0.248, respectively; P < 0.001 for each). A strong association was demonstrated between the rate of air filtration and the mean number of MRSA cfu/10-h exposure/plate (P for trend < 0.001). In conclusion, this portable HEPA-filtration unit can significantly reduce MRSA environmental contamination within patient isolation rooms, and this may prove to be a useful addition to existing MRSA infection control measures. PMID:16517004

  7. Costs and Benefits Associated with the MRSA Search and Destroy Policy in a Hospital in the Region Kennemerland, The Netherlands

    PubMed Central

    Souverein, Dennis; Houtman, Patricia; Euser, Sjoerd M.; Herpers, Bjorn L.; Kluytmans, Jan; Den Boer, Jeroen W.

    2016-01-01

    Objective The objective of this study was to analyze the costs and benefits of the MRSA Search and Destroy (S&D) policy between 2008 and 2013 in the Kennemer Gasthuis, a 400 bed teaching hospital in the region Kennemerland, the Netherlands. Methods A patient registration database was used to retrospectively calculate costs, including screening, isolation, follow-up, contact tracing, cleaning, treatment, deployment of extra healthcare workers, salary for an infection control practitioner (ICP) and service of isolation rooms. The estimated benefits (costs and lives when no MRSA S&D was applied) were based on a varying MRSA prevalence rate (up to 50%). Results When no MRSA S&D policy was applied, the additional costs and deaths due to MRSA bacteraemia were estimated to be € 1,388,907 and 33 respectively (at a MRSA prevalence rate of 50%). Currently, the total costs were estimated to be € 290,672 (€ 48,445 annually) and a MRSA prevalence rate of 17.3% was considered as break-even point. Between 2008 and 2013, a total of 576 high risk patients were screened for MRSA carriage, of whom 19 (3.3%) were found to be MRSA positive. Forty-nine patients (72.1%) were found unexpectedly. Conclusions Application of the MRSA S&D policy saves lives and money, although the high rate of unexpected MRSA cases is alarming. PMID:26849655

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

    PubMed Central

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

    2014-01-01

    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. PMID:22309135

  9. Analysis of Transmission of MRSA and ESBL-E among Pigs and Farm Personnel

    PubMed Central

    Stemmer, Franziska; El-Jade, Mohamed; Reif, Marion; Hack, Sylvia; Meilaender, Alina; Montabauer, Gabriele; Fimmers, Rolf; Parcina, Marijo; Hoerauf, Achim; Exner, Martin; Petersen, Brigitte; Bierbaum, Gabriele; Bekeredjian-Ding, Isabelle

    2015-01-01

    Livestock-associated bacteria with resistance to two or more antibiotic drug classes have heightened our awareness for the consequences of antibiotic consumption and spread of resistant bacterial strains in the veterinary field. In this study we assessed the prevalence of concomitant colonization with livestock-associated methicillin-resistant Staphylococcus aureus (LA-MRSA) and enterobacteriaceae expressing extended-spectrum betalactamases (ESBL-E) in farms at the German-Dutch border region. Nasal colonization of pigs with MRSA (113/547 (20.7%)) was less frequent than rectal colonization with ESBL-E (163/540 (30.2%)). On the individual farm level MRSA correlated with ESBL-E recovery. The data further provide information on prevalence at different stages of pig production, including abattoirs, as well as in air samples and humans living and working on the farms. Notably, MRSA was detected in stable air samples of 34 out of 35 pig farms, highlighting air as an important MRSA transmission reservoir. The majority of MRSA isolates, including those from humans, displayed tetracycline resistance and spa types t011 and t034 characteristic for LA-MRSA, demonstrating transmission from pigs to humans. ESBL-E positive air samples were detected on 6 out of 35 farms but no pig-to-human transmission was found. Detection of ESBL-E, e.g. mostly Escherichia coli with CTX-M-type ESBL, was limited to these six farms. Molecular typing revealed transmission of ESBL-E within the pig compartments; however, related strains were also found on unrelated farms. Although our data suggest that acquisition of MRSA and ESBL-E might occur among pigs in the abattoirs, MRSA and ESBL-E were not detected on the carcasses. Altogether, our data define stable air (MRSA), pig compartments (ESBL-E) and abattoir waiting areas (MRSA and ESBL-E) as major hot spots for transmission of MRSA and/or ESBL-E along the pig production chain. PMID:26422606

  10. Analysis of Transmission of MRSA and ESBL-E among Pigs and Farm Personnel.

    PubMed

    Schmithausen, Ricarda Maria; Schulze-Geisthoevel, Sophia Veronika; Stemmer, Franziska; El-Jade, Mohamed; Reif, Marion; Hack, Sylvia; Meilaender, Alina; Montabauer, Gabriele; Fimmers, Rolf; Parcina, Marijo; Hoerauf, Achim; Exner, Martin; Petersen, Brigitte; Bierbaum, Gabriele; Bekeredjian-Ding, Isabelle

    2015-01-01

    Livestock-associated bacteria with resistance to two or more antibiotic drug classes have heightened our awareness for the consequences of antibiotic consumption and spread of resistant bacterial strains in the veterinary field. In this study we assessed the prevalence of concomitant colonization with livestock-associated methicillin-resistant Staphylococcus aureus (LA-MRSA) and enterobacteriaceae expressing extended-spectrum betalactamases (ESBL-E) in farms at the German-Dutch border region. Nasal colonization of pigs with MRSA (113/547 (20.7%)) was less frequent than rectal colonization with ESBL-E (163/540 (30.2%)). On the individual farm level MRSA correlated with ESBL-E recovery. The data further provide information on prevalence at different stages of pig production, including abattoirs, as well as in air samples and humans living and working on the farms. Notably, MRSA was detected in stable air samples of 34 out of 35 pig farms, highlighting air as an important MRSA transmission reservoir. The majority of MRSA isolates, including those from humans, displayed tetracycline resistance and spa types t011 and t034 characteristic for LA-MRSA, demonstrating transmission from pigs to humans. ESBL-E positive air samples were detected on 6 out of 35 farms but no pig-to-human transmission was found. Detection of ESBL-E, e.g. mostly Escherichia coli with CTX-M-type ESBL, was limited to these six farms. Molecular typing revealed transmission of ESBL-E within the pig compartments; however, related strains were also found on unrelated farms. Although our data suggest that acquisition of MRSA and ESBL-E might occur among pigs in the abattoirs, MRSA and ESBL-E were not detected on the carcasses. Altogether, our data define stable air (MRSA), pig compartments (ESBL-E) and abattoir waiting areas (MRSA and ESBL-E) as major hot spots for transmission of MRSA and/or ESBL-E along the pig production chain. PMID:26422606

  11. Prevalence and molecular characteristics of methicillin-resistant Staphylococcus aureus (MRSA) among subjects working on bovine dairy farms.

    PubMed

    Antoci, Eugenio; Pinzone, Marilia Rita; Nunnari, Giuseppe; Stefani, Stefania; Cacopardo, Bruno

    2013-06-01

    Methicillin-resistant Staphylococcus aureus (MRSA) is a major cause of healthcare-associated infections worldwide and has recently been identified as an emerging pathogen in livestock and companion animals. Livestock-associated MRSA (LA-MRSA) may be responsible for increased rates of colonization and/or infection among people working on farms. We evaluated the prevalence and molecular characteristics of MRSA among dairy farmers in the province of Ragusa, South-Eastern Sicily, their animals and bulk tank milk samples. A surprisingly high number of samples tested positive for MRSA: 36% of human nasal swabs, 61% of bovine nasal swabs and 44% of bulk tank milk samples. MRSA carrier prevalence in humans significantly correlated with the percentage of positive cows on the farm, the number of livestock units and the presence of consensual positive bulk tank milk samples. Prospective studies are needed to investigate MRSA transmission between animals and humans and implement preventive strategies. PMID:23774976

  12. Prevalence and molecular characteristics of methicillin-resistant Staphylococcus aureus (MRSA) in organic pig herds in The Netherlands.

    PubMed

    van de Vijver, L P L; Tulinski, P; Bondt, N; Mevius, D; Verwer, C

    2014-08-01

    The prevalence of the methicillin-resistant Staphylococcus aureus (MRSA) among conventional pig herds in the Netherlands is high (around 71%). Nevertheless, information about the prevalence of MRSA among organic pig herds is lacking. Here, we report a study on 24 of the 49 organic pig herds in the Netherlands. The prevalence of MRSA positive herds showed to be 21%. The genetic characteristics of the MRSA isolates were similar to MRSA CC398 described in conventional pigs except one exceptional HA-MRSA CC30 found in one herd, which was presumably caused by human to animal transmission. This resulted in a prevalence of MRSA CC398 in the organic herds of 16.7%. PMID:24751151

  13. In vitro antimicrobial activity of T-91825, a novel anti-MRSA cephalosporin, and in vivo anti-MRSA activity of its prodrug, TAK-599.

    PubMed

    Iizawa, Yuji; Nagai, Junko; Ishikawa, Tomoyasu; Hashiguchi, Shohei; Nakao, Masafumi; Miyake, Akio; Okonogi, Kenji

    2004-06-01

    TAK-599 is a water-soluble prodrug of a cephalosporin compound, T-91825. In vitro and in vivo antibacterial activities of T-91825 and TAK-599, respectively, were examined. T-91825 was active against both gram-positive and gram-negative bacteria, unlike vancomycin and linezolid, which are inactive against gram-negative bacteria. The 90% minimum inhibitory concentration of T-91825 against clinical isolates of methicillin-resistant Staphylococcus aureus (MRSA) was 2 micro g/ml. This activity was comparable to those of vancomycin, linezolid, teicoplanin, and arbekacin. T-91825 was similarly active against vancomycin-intermediate S. aureus. In a time-kill study, T-91825 showed more rapid and distinct decrease of viable cells of two MRSA strains than did vancomycin and linezolid in vitro. The effect of TAK-599 against systemic infection caused by clinical isolates of MRSA in mice was comparable or superior to that of vancomycin, linezolid, teicoplanin, and arbekacin. In addition, TAK-599 at a dose of 20 mg/kg significantly decreased bacterial counts in lungs of mice in an experimental pneumonia model caused by MRSA in which vancomycin and linezolid were totally ineffective at the same dose. These results suggest the usefulness of TAK-599 in the treatment of MRSA infections in humans. PMID:15290453

  14. Clinical Characteristics, Treatments, and Prognosis of Atopic Eczema in the Elderly

    PubMed Central

    Tanei, Ryoji

    2015-01-01

    Atopic eczema (AE) in the elderly is gradually increasing and has been added to the classification of AE in recent years. This investigation retrospectively analyzed 60 patients with elderly AE. Among the clinical characteristics, a male predominance, existence of several patterns of onset and clinical course, and associations with immunoglobulin (Ig)E-allergic-status and asthmatic complication were observed. The highest positive-rate and positive-score for serum-specific IgE against Dermatophagoides farinae were 83.8% and 2.65 in patients with IgE-allergic AE, and a lower incidence of lichenified eczema in the elbow and knee folds were observed. In terms of treatments and outcomes, clinical improvement and clinical remission were observed in 80.8% and 36.5% of cases, respectively, using standard treatments and combined therapy with oral corticosteroid in severe cases. As for complications and final prognosis, most elderly AE patients reached the end of life with AE, but patients with IgE-allergic AE showed significantly lower incidences of complications of malignancy and death from malignancy. These results indicate that AE in the elderly represents a new subgroup of AE with specific features. PMID:26239460

  15. Cecal ligation and puncture followed by MRSA pneumonia increases mortality in mice and blunts production of local and systemic cytokines

    PubMed Central

    Jung, Enjae; Perrone, Erin E.; Liang, Zhe; Breed, Elise R.; Dominguez, Jessica A.; Clark, Andrew T.; Fox, Amy C.; Dunne, W. Michael; Burd, Eileen M.; Farris, Alton B.; Hotchkiss, Richard S.; Coopersmith, Craig M.

    2011-01-01

    Mortality in the ICU frequently results from the synergistic effect of two temporally-distinct infections. This study examined the pathophysiology of a new model of intraabdominal sepsis followed by methicillin-resistant Staphylococcus aureus (MRSA) pneumonia. Mice underwent cecal ligation and puncture (CLP) or sham laparotomy followed three days later by an intratracheal injection of MRSA or saline. Both CLP/saline and sham/MRSA mice had 100% survival while animals with CLP followed by MRSA pneumonia had 67% seven-day survival. Animals subjected to CLP/MRSA had increased bronchoalveolar lavage (BAL) concentrations of MRSA compared to sham/MRSA animals. Animals subjected to sham/MRSA pneumonia had increased BAL levels of IL-6, TNF-α, and G-CSF compared to those given intratracheal saline while CLP/MRSA mice had a blunted local inflammatory response with markedly decreased cytokine levels. Similarly, animals subjected to CLP/saline had increased peritoneal lavage levels of IL-6 and IL-1β compared to those subjected to sham laparotomy while this response was blunted in CLP/MRSA mice. Systemic cytokines were upregulated in both CLP/saline and sham/MRSA mice, and this was blunted by the combination of CLP/MRSA. In contrast, no synergistic effect on pneumonia severity, white blood cell count or lymphocyte apoptosis was identified in CLP/MRSA mice compared to animals with either insult in isolation. These results indicate that a clinically relevant model of CLP followed by MRSA pneumonia causes higher mortality than could have been predicted from studying either infection in isolation, and this was associated with a blunted local (pulmonary and peritoneal) and systemic inflammatory response and decreased ability to clear infection. PMID:21937950

  16. Protocol for a randomised trial on the effect of group education on skin-protective behaviour versus treatment as usual among individuals with newly notified occupational hand eczema – the Prevention of Hand Eczema (PREVEX) Trial

    PubMed Central

    2013-01-01

    Background The incidence of occupational hand eczema is approximately 0.32 per 1,000 person years. The burden of the disease is high, as almost 60% has eczema-related sick leave during the first year after notification, and 15% are excluded from the workforce 12 years after disease onset. New treatments and prevention strategies are needed. Methods/Design Trial design: The PREVEX trial is a randomised, parallel-group, superiority trial. Participants: All individuals from the Capital Region of Denmark and Region Zealand with a suspected occupational skin disorder notified to the National Board of Industrial Injuries between June 2012 and December 2013 are invited to participate in the trial. Inclusion criteria are: self-reported hand eczema and informed consent. Exclusion criteria are: age <18 years or >65 years; permanent exclusion from the workforce; inability to understand the Danish language; any serious medical condition; and lack of written informed consent. We plan to randomise 742 participants. Interventions: The experimental intervention is an educational course in skin-protective behaviour and written information about skin care related to the participants' specific occupation. Also, a telephone hotline is available and a subgroup will be offered a work-place visit. The experimental and the control group have access to usual care and treatment. All participants are contacted every eighth week with questions regarding number of days with sick leave or other absence from work. 12 months after randomisation follow-up is completed. Objective: To assesses the effect of an educational course versus treatment as usual in participants with newly notified occupational hand eczema. Randomisation: Participants are centrally randomised according to a computer-generated allocation sequence with a varying block size concealed to investigators. Blinding: It is not possible to blind the participants and investigators, however, data obtained from registers, data entry, statistical analyses, and drawing of conclusions will be blinded. Outcomes: The three co-primary outcomes, assessed at 12 months, are: total number of self-reported days with sick leave; health-related quality of life; and subjective assessment of hand eczema severity. Explorative outcomes are: self-reported eczema-related sick leave, absence from work registered by the DREAM-register and by self-report, risk behaviour, knowledge of skin protection and performance management (self-efficacy; and self-evaluated ability to self-care). Discussion The PREVEX trial will be the first individually randomised trial to investigate the benefits and harms of group-based education in patients with newly notified occupational hand eczema. Trial registration ClinicalTrials.gov Identifier: NCT01899287 PMID:24245553

  17. Structural Insights into the Anti-methicillin-resistant Staphylococcus aureus (MRSA) Activity of Ceftobiprole*

    PubMed Central

    Lovering, Andrew L.; Gretes, Michael C.; Safadi, Susan S.; Danel, Franck; de Castro, Liza; Page, Malcolm G. P.; Strynadka, Natalie C. J.

    2012-01-01

    Methicillin-resistant Staphylococcus aureus (MRSA) is an antibiotic-resistant strain of S. aureus afflicting hospitals and communities worldwide. Of greatest concern is its development of resistance to current last-line-of-defense antibiotics; new therapeutics are urgently needed to combat this pathogen. Ceftobiprole is a recently developed, latest generation cephalosporin and has been the first to show activity against MRSA by inhibiting essential peptidoglycan transpeptidases, including the β-lactam resistance determinant PBP2a, from MRSA. Here we present the structure of the complex of ceftobiprole bound to PBP2a. This structure provides the first look at the molecular details of an effective β-lactam-resistant PBP interaction, leading to new insights into the mechanism of ceftobiprole efficacy against MRSA. PMID:22815485

  18. Antagonism of chemical genetic interaction networks resensitize MRSA to β-lactam antibiotics.

    PubMed

    Lee, Sang Ho; Jarantow, Lisa Wang; Wang, Hao; Sillaots, Susan; Cheng, Henry; Meredith, Timothy C; Thompson, John; Roemer, Terry

    2011-11-23

    Antibiotic drug resistance among hospital and community acquired methicillin resistant Staphylococcus aureus (MRSA) has dramatically eroded the efficacy of current therapeutics. We describe a chemical genetic strategy using antisense interference to broadly identify new drug targets that potentiate the effects of existing antibiotics against both etiological classes of MRSA infection. Further, we describe the resulting chemical genetic interaction networks and highlight the prominent and overlapping target sets that restore MRSA susceptibility to penicillin, cephalosporins, and carbapenems. Pharmacological validation of this approach is the potent synergy between a known inhibitor to a member of this genetic potentiation network (GlmS) and a broad set of β-lactam antibiotics against methicillin resistant Staphylococci. Developing drug-like leads to these targets may serve as rational and effective combination agents when paired with existing β-lactam antibiotics to restore their efficacy against MRSA. PMID:22118672

  19. The enduring menace of MRSA: incidence, treatment, and prevention in a county jail.

    PubMed

    Deger, Grant E; Quick, David W

    2009-07-01

    Nationwide, methicillin-resistant Staphylococcus aureus (MRSA) presents an increasing hazard to inmates. This article reviews our 1-year (2005) experience with skin and soft tissue infections (SSTIs) in a medium-sized county jail. As part of a quality assurance process, the authors cultured every SSTI presenting to our institution. The authors found that a full 68% of SSTIs (50 of 74) were MRSA species, and new MRSA cases presented regularly throughout the year. Inmates usually have poor understanding of infectious processes and need constant support and education. Correctional health care providers must approach their antibiotic treatment for today's SSTIs with the knowledge that MRSA is very common. This article reviews treatment options, preventive measures, and institutional hygiene. PMID:19477805

  20. Intra-strain variability of methicillin-resistant Staphylococcus aureus strains ST228-MRSA-I and ST5-MRSA-II.

    PubMed

    Monecke, S; Ehricht, R; Slickers, P; Wiese, N; Jonas, D

    2009-11-01

    Isolates belonging to two major epidemic strains of methicillin-resistant Staphylococcus aureus (MRSA) from clonal complex 5 were characterised using diagnostic microarrays in order to detect and analyse intra-strain variability. Isolates were sampled from hospitals scattered all over Germany. The study included 56 isolates of ST228-MRSA-I, which is also known as the South German Epidemic Strain, and 40 isolates of ST5-MRSA-II (UK-EMRSA-3, Rhine-Hesse Epidemic Strain, New York/Japan Clone), as well as, for comparison, some control strains and overseas isolates of ST5-MRSA-II. Both strains showed a remarkable variability. This affected plasmid-borne resistance genes (tetK, blaZ/R/I, aacA-aphD, qacA), genes from SCCmec elements (aadD, ermA, merA/B/R/T), toxin gene clusters on pathogenicity islands (sec/l, tst1) or, probably, on plasmids, (sed/j/r), the presence or absence of beta-haemolysin-converting phages (sea, sea-N315, sak, chp, scn), deletions of single chromosomal genes (bbp, clfA) or, occasionally, of rather large clusters of neighbouring genes (seg, sei, sem, sen, seo, seu, lukD/E). Both strains could be split into four major clusters each, based on the presence of a mercury resistance operon (merA/B/R/T) and lukD/E in ST228-MRSA-I or of tst1 and enterotoxin genes seD/J/R in ST5-MRSA-II. The use of this variability for typing purposes as well as its phylogenetic significance are discussed. PMID:19693551

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

    SciTech Connect

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

    1985-06-01

    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.

  2. Analysis of MRSA-attributed costs of hospitalized patients in Germany.

    PubMed

    Hübner, C; Hübner, N-O; Hopert, K; Maletzki, S; Flessa, S

    2014-10-01

    Infections with methicillin-resistant Staphylococcus aureus (MRSA) are assumed to have a high economic impact due to increased hygienic measures and prolonged hospital length of stay. However, surveys on the real expenditure for the prevention and treatment of MRSA are scarce, in particular with regard to the German Diagnosis-Related Groups (G-DRG) payment system. The aim of our study is to empirically assess the additional cost for MRSA management measures and to identify the main cost drivers in the whole process from the hospital's point of view. We conducted a one-year retrospective analysis of MRSA-positive cases in a German university hospital and determined the cost of hygienic measures, laboratory costs, and opportunity costs due to isolation time and extended lengths of stay. A total of 182 cases were included in the analysis. The mean length of hospital stay was 22.75 days and the mean time in isolation was 17.08 days, respectively. Overall, the calculated MRSA-attributable costs were 8,673.04 per case, with opportunity costs making up, by far, the largest share (77.45 %). Our study provides a detailed up-to-date analysis of MRSA-attributed costs in a hospital. It allows a current comparison to previous studies worldwide. Moreover, it offers the prerequisites to investigate the adequate reimbursement of MRSA burden in the DRG payment system and to assess the efficiency of targeted hygienic measures in the prevention of MRSA. PMID:24838677

  3. Microarray analysis reveals marked intestinal microbiota aberrancy in infants having eczema compared to healthy children in at-risk for atopic disease

    PubMed Central

    2013-01-01

    Background Deviations in composition and diversity of intestinal microbiota in infancy have been associated with both the development and recurrence of atopic eczema. Thus, we decided to use a deep and global microarray-based method to characterize the diversity and temporal changes of the intestinal microbiota in infancy and to define specific bacterial signatures associated with eczema. Faecal microbiota at 6 and 18 months of age were analysed from 34 infants (15 with eczema and 19 healthy controls) selected from a prospective follow-up study based on the availability of faecal samples. The infants were originally randomized to receive either Lactobacillus rhamnosus GG or placebo. Results Children with eczema harboured a more diverse total microbiota than control subjects as assessed by the Simpson’s reciprocal diversity index of the microarray profiles. Composition of the microbiota did not differ between study groups at age of 6 months, but was significantly different at age of 18 months as assessed by MCPP (p=0.01). At this age healthy children harboured 3 -fold greater amount of members of the Bacteroidetes (p=0.01). Microbiota of children suffering from eczema had increased abundance of the Clostridium clusters IV and XIVa, which are typically abundant in adults. Probiotic Lactobacillus rhamnosus GG supplementation in early infancy was observed to have minor long-term effects on the microbiota composition. Conclusion A diverse and adult-type microbiota in early childhood is associated with eczema and it may contribute to the perpetuation of eczema. PMID:23339708

  4. Staphylococcus aureus and methicillin-resistant S. aureus (MRSA) at ambient freshwater beaches

    USGS Publications Warehouse

    Fogarty, Lisa R.; Haack, Sheridan K.; Johnson, Heather E.; Brennan, Angela K.; Isaacs, Natasha M.; Spencer, Chelsea

    2015-01-01

    Methicillin-resistant Staphylococcus aureus (MRSA) are a threat to human health worldwide, and although detected at marine beaches, they have been largely unstudied at freshwater beaches. Genes indicating S. aureus (SA; femA) and methicillin resistance (mecA) were detected at 11 and 12 of 13 US Great Lakes beaches and in 18% or 27% of 287 recreational water samples, respectively. Eight beaches had mecA + femA (potential MRSA) detections. During an intensive study, higher bather numbers, staphylococci concentrations, and femA detections were found in samples collected after noon than before noon. Local population density, beach cloud cover, and beach wave height were significantly correlated with SA or MRSA detection frequency. The Panton-Valentine leukocidin gene, associated with community-acquired MRSA, was detected in 12 out of 27 potential MRSA samples. The femA gene was detected less frequently at beaches that met US enterococci criteria or EU enterococci ‘excellent’ recreational water quality, but was not related to Escherichia coli-defined criteria. Escherichia coli is often the only indicator used to determine water quality at US beaches, given the economic and healthcare burden that can be associated with infections caused by SA and MRSA, monitoring of recreational waters for non-fecal bacteria such as staphylococci and/or SA may be warranted.

  5. [Antibiotics for treatment of infections by methicillin-resistant Staphylococcus aureus (MRSA)].

    PubMed

    Stahlmann, R

    2014-10-01

    Over the last 50 years methicillin-resistant S. aureus (MRSA) spread globally. Vancomycin is still the most recommended antibiotic for MRSA-infections. Teicoplanin is an alternative glycopeptide with longer elimination half-life. Telavancin is a more recently developed derivative of vancomycin with similar clinical efficacy as vancomycin. It is not recommended for treatment of patients with renal insufficiency. Nephrotoxicity limits the therapeutic use of glycopeptide antibiotics. The oxazolidinone linezolid exhibits similar to superior therapeutic efficacy. Hematologic controls are necessary during treatment with this antibacterial agent. Neurotoxic effects have been observed mainly in patients who received prolonged linezolid treatment. Attention must be paid to possible interactions with concomitantly given drugs acting on the serotonergic system. New therapeutic options arise with ceftaroline, the first β-lactam antibiotic with activity against MRSA. However, controlled clinical trials with pulmonary MRSA infections have not been conducted with ceftaroline. Daptomycin, a lipopeptide, and tigecycline, a glycylcyclin are active in vitro against MRSA as well, but are also not indicated in pulmonary MRSA infections. These antibiotics show in an exemplary manner that antibacterial activity in vitro is an important prerequisite, but relevant data for a therapeutic decision should be derived from randomized controlled clinical double-blind trials. PMID:25290922

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

    PubMed

    Kraushaar, Britta; Fetsch, Alexandra

    2014-09-01

    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

  7. Staphylococcus aureus and methicillin-resistant S. aureus (MRSA) at ambient freshwater beaches.

    PubMed

    Fogarty, Lisa R; Haack, Sheridan K; Johnson, Heather E; Brennan, Angela K; Isaacs, Natasha M; Spencer, Chelsea

    2015-09-01

    Methicillin-resistant Staphylococcus aureus (MRSA) are a threat to human health worldwide, and although detected at marine beaches, they have been largely unstudied at freshwater beaches. Genes indicating S. aureus (SA; femA) and methicillin resistance (mecA) were detected at 11 and 12 of 13 US Great Lakes beaches and in 18% or 27% of 287 recreational water samples, respectively. Eight beaches had mecA+femA (potential MRSA) detections. During an intensive study, higher bather numbers, staphylococci concentrations, and femA detections were found in samples collected after noon than before noon. Local population density, beach cloud cover, and beach wave height were significantly correlated with SA or MRSA detection frequency. The Panton-Valentine leukocidin gene, associated with community-acquired MRSA, was detected in 12 out of 27 potential MRSA samples. The femA gene was detected less frequently at beaches that met US enterococci criteria or EU enterococci 'excellent' recreational water quality, but was not related to Escherichia coli-defined criteria. Escherichia coli is often the only indicator used to determine water quality at US beaches, given the economic and healthcare burden that can be associated with infections caused by SA and MRSA, monitoring of recreational waters for non-fecal bacteria such as staphylococci and/or SA may be warranted. PMID:26322754

  8. Harnessing the power of light to treat staphylococcal infections focusing on MRSA.

    PubMed

    Agrawal, Tanupriya; Avci, Pinar; Gupta, Gaurav K; Rineh, Ardeshir; Lakshmanan, Shanmugamurthy; Batwala, Vincent; Tegos, George P; Hamblin, Michael R

    2015-01-01

    Methicillin-resistant Staphylococcus aureus (MRSA) has become the most important drug-resistant microbial pathogen in countries throughout the world. Morbidity and mortality due to MRSA infections continue to increase despite efforts to improve infection control measures and to develop new antibiotics. Therefore alternative antimicrobial strategies that do not give rise to development of resistance are urgently required. A group of therapeutic interventions has been developed in the field of photomedicine with the common theme that they rely on electromagnetic radiation with wavelengths between 200 and 1000 nm broadly called "light". These techniques all use simple absorption of photons by specific chromophores to deliver the killing blow to microbial cells while leaving the surrounding host mammalian cells relatively unharmed. Photodynamic inactivation uses dyes called photosensitizers (PS) that bind specifically to MRSA cells and not host cells, and generate reactive oxygen species including singlet oxygen and singlet oxygen upon illumination. Sophisticated molecular strategies to target the PS to MRSA cells have been designed. Ultraviolet C radiation can damage microbial DNA without unduly harming host DNA. Blue light can excite endogenous porphyrins and flavins in MRSA cells that are not present in host cells. Near-infrared lasers can interfere with microbial membrane potentials without raising the temperature of the tissue. Taken together these innovative approaches towards harnessing the power of light suggest that the ongoing threat of MRSA may eventually be defeated. PMID:25760339

  9. Descriptive Analysis of Antibiotic-Resistant Patterns of Methicillin-Resistant Staphylococcus aureus (MRSA) st398 Isolated from Healthy Swine

    PubMed Central

    Morcillo, Ana; Castro, Beatriz; Rodríguez-Álvarez, Cristobalina; Abreu, Rossana; Aguirre-Jaime, Armando; Arias, Angeles

    2015-01-01

    Background: Livestock-associated methicillin-resistant Staphylococcus aureus (MRSA) such as the MRSA ST398 strain has spread all over the World and the most worrying aspect of this fact appears to be its capacity to easily spread to humans. The excessive use of antibiotics has made swine a reservoir of MRSA. The aim of the present study was to determine the antibiotic resistance profile of MRSA samples isolated from healthy swine of the island of Tenerife (Spain). Methods: A total of 256 MRSA isolates from swine samples and five MRSA isolates from pig worker samples were investigated for MRSA antibiotic resistant patterns. Results: Analysis of the susceptibility status of MRSA pig isolates revealed that 39 isolates were resistant to one antibiotic, 71 isolates were resistant to two antibiotics and 96 isolates were resistant to three or more antibiotics. SCCmec typing revealed the presence of types IV and V. Isolates having SCCmec IV had an increased resistance to the antimicrobial agents tested than those having SCCmec V. We observed significant differences when comparing the most common resistance patterns and SCCmec type. Conclusions: MRSA isolated from humans showed similar resistance to those isolated from pigs, excepting erythromycin, since all the workers’ isolates were sensitive to this antibiotic. The evolution of new MRSA clones has emphasized the need for infection control practices in animals and humans in close contact. PMID:25588155

  10. Genotypic and phenotypic characteristics of Methicillin-resistant Staphylococcus aureus (MRSA) strains, isolated on three different geography locations.

    PubMed

    Ostoji?, Maja; Huki?, Mirsada

    2015-01-01

    Staphylococcus aureus is a major cause of hospital-acquired infections worldwide. Increased frequency of methicillin-resistant Staphylococcus aureus (MRSA) in hospitalized patients and possibility of vancomycin resistance requires rapid and reliable characterization of isolates and control of MRSA spread in hospitals. Typing of isolates helps to understand the route of a hospital pathogen spread. The aim of this study was to investigate and compare genotypic and phenotypic characteristics of MRSA samples on three different geography locations. In addition, our aim was to evaluate three different methods of MRSA typing: spa-typing, agr-typing and GenoType MRSA. We included 104 samples of MRSA, isolated in 3 different geographical locations in clinical hospitals in Zagreb, Mostar, and Heidelberg, during the period of six months. Genotyping and phenotyping were done by spa-typing, agr-typing and dipstick assay GenoType MRSA. We failed to type all our samples by spa-typing. The most common spa-type in clinical hospital Zagreb was t041, in Mostar t001, and in Heidelberg t003.We analyzed 102/104 of our samples by agr-typing method. We did not find any agr-type IV in our locations. We analyzed all our samples by the dipstick assay GenoType MRSA. All isolates in our study were MRSA strains. In Zagreb there were no positive strains to PVL gene. In Mostar we have found 5/25 positive strains to PVL gene, in Heidelberg there was 1/49. PVL positive isolates were associated with spa-type t008 and agr-type I, thus, genetically, they were community-associated MRSA (CA-MRSA). Dipstick assay GenoType MRSA has demonstrated sufficient specificity, sensibility, simple performance and low cost, so we could introduce it to work in smaller laboratories. Using this method may expedite MRSA screening, thus preventing its spread in hospitals. PMID:26295294

  11. Genotypic and phenotypic characteristics of Methicillin-resistant Staphylococcus aureus (MRSA) strains, isolated on three different geography locations

    PubMed Central

    Ostojić, Maja; Hukić, Mirsada

    2015-01-01

    Staphylococcus aureus is a major cause of hospital-acquired infections worldwide. Increased frequency of methicillin-resistant Staphylococcus aureus (MRSA) in hospitalized patients and possibility of vancomycin resistance requires rapid and reliable characterization of isolates and control of MRSA spread in hospitals. Typing of isolates helps to understand the route of a hospital pathogen spread. The aim of this study was to investigate and compare genotypic and phenotypic characteristics of MRSA samples on three different geography locations. In addition, our aim was to evaluate three different methods of MRSA typing: spa-typing, agr-typing and GenoType MRSA. We included 104 samples of MRSA, isolated in 3 different geographical locations in clinical hospitals in Zagreb, Mostar, and Heidelberg, during the period of six months. Genotyping and phenotyping were done by spa-typing, agr-typing and dipstick assay GenoType MRSA. We failed to type all our samples by spa-typing. The most common spa-type in clinical hospital Zagreb was t041, in Mostar t001, and in Heidelberg t003. We analyzed 102/104 of our samples by agr-typing method. We did not find any agr-type IV in our locations. We analyzed all our samples by the dipstick assay GenoType MRSA. All isolates in our study were MRSA strains. In Zagreb there were no positive strains to PVL gene. In Mostar we have found 5/25 positive strains to PVL gene, in Heidelberg there was 1/49. PVL positive isolates were associated with spa-type t008 and agr-type I, thus, genetically, they were community-associated MRSA (CA-MRSA). Dipstick assay GenoType MRSA has demonstrated sufficient specificity, sensibility, simple performance and low cost, so we could introduce it to work in smaller laboratories. Using this method may expedite MRSA screening, thus preventing its spread in hospitals. PMID:26295294

  12. Predicting the virulence of MRSA from its genome sequence

    PubMed Central

    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

    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

  13. 'Post antibiotic apocalypse': discourses of mutation in narratives of MRSA.

    PubMed

    Brown, Brian; Crawford, Paul

    2009-05-01

    In this paper we will consider the question of mutation as it is manifested in press coverage of MRSA in UK hospitals. This represents a fertile field of discourse which brings into focus issues relating to microbes, people and working practices as well as the concepts of risk and vulnerability. A regular feature of reporting has been the presence of explanations for drug resistance involving repeated random mutations of the microbe to achieve progressively greater resistance and versatility, largely through a Darwinian process which is 'clever' at overcoming human attempts at elimination. More recently a discourse has emerged which foregrounds also the vulnerability of patients who are very young, old or otherwise immunocompromised, or whose own genetic makeup might put them at risk from the microbe. The hospital is decentred as a source of infection, and attention is turned instead to nursing homes and gymnasia as sources of infection in the community. This latter development mitigates the responsibilities of hospitals and statutory healthcare providers and turns the risk back towards the individual as a responsible actor in an ecology of mutation. PMID:19144082

  14. Siblings, asthma, rhinoconjunctivitis and eczema: a worldwide perspective from the International Study of Asthma and Allergies in Childhood

    PubMed Central

    Strachan, D P; Aït-Khaled, N; Foliaki, S; Mallol, J; Odhiambo, J; Pearce, N; Williams, H C

    2015-01-01

    Background Associations of larger families with lower prevalences of hay fever, eczema and objective markers of allergic sensitization have been found fairly consistently in affluent countries, but little is known about these relationships in less affluent countries. Methods Questionnaire data for 210 200 children aged 6–7 years from 31 countries, and 337 226 children aged 13–14 years from 52 countries, were collected by Phase Three of the International Study of Asthma and Allergies in Childhood (ISAAC). Associations of disease symptoms and labels of asthma, rhinoconjunctivitis and eczema were analysed by numbers of total, older and younger siblings, using mixed (multi-level) logistic regression models to adjust for individual covariates and at the centre level for region, language and national affluence. Results In both age groups, inverse trends (P < 0.0001) were observed for reported ‘hay fever ever’ and ‘eczema ever’ with increasing numbers of total siblings, and more specifically older siblings. These inverse associations were significantly (P < 0.005) stronger in more affluent countries. In contrast, symptoms of severe asthma and severe eczema were positively associated (P < 0.0001) with total sibship size in both age groups. These associations with disease severity were largely independent of position within the sibship and national GNI per capita. Conclusions These global findings on sibship size and childhood asthma, rhinoconjunctivitis and eczema suggest at least two distinct trends. Inverse associations with older siblings (observations which prompted the ‘hygiene hypothesis’ for allergic disease) are mainly a phenomenon of more affluent countries, whereas greater severity of symptoms in larger families is globally more widespread. PMID:24912652

  15. Risk factors for eczema in infants born in Cuba: a population-based cross-sectional study

    PubMed Central

    2014-01-01

    Background There is a concern that allergic disease in childhood is higher than expected in Cuba. The aim of this study was to determine the risk factors for eczema of infants aged 12–15 months living in Havana. Methods We used a cross-sectional epidemiological study design. Data on eczema symptoms and a wide range of lifestyle factors were collected by researcher administered questionnaires. Results Data were collected on 1956 children (96% response rate), of whom 672 (34%) were reported as having had eczema. Independent risk factors for eczema included young maternal age (adjusted odds ratio (OR) 0.98 per additional year of age; 95% confidence interval (CI) 0.97-0.99), child’s weight (OR 1.13 per additional kg; 95% CI: 1.03-1.25), insect sting allergy (OR 2.11; 95% CI: 1.33-3.35), rodents in the home (OR 1.39; 95% CI: 1.10-1.76), attendance at childcare facilities (OR 1.34: 95% CI: 1.05-1.70) and self-reported mould in the home (OR 1.23; 95% CI: 1.07-1.41). Infant exposure to paracetamol was associated with an increased risk of eczema even after adjustment for wheeze (OR 1.22; 95% CI: 1.03-1.46). Conclusion Despite a very different culture and environment, the consistency of these findings with those from more economically developed countries suggests potential causal associations. The association with paracetamol, even after adjustment for wheeze, suggests that intervention studies are required in young infants, to ascertain if this commonly used anti-pyretic medication increases allergic disease. PMID:24666750

  16. A pilot study on the use of wet wraps in infants with moderate atopic eczema.

    PubMed

    Beattie, P E; Lewis-Jones, M S

    2004-07-01

    Wet wrap therapy (WWT) is a well-established treatment for severe atopic dermatitis (AD). However little evidence exists to justify widespread use in the community for less severe eczema. We compared the efficacy of WWT with a standard regime of hydrocortisone, to control moderate AD in children. We carried out a single-observer, randomized, controlled pilot study in 19 children under 5 years of age, with AD of 30% or more body surface area, using only 1% hydrocortisone (HC) prior to the study. Group one applied HC once in the morning for 2 weeks, with wet wraps twice daily for week 1, but only at night for week 2. Group two applied HC twice daily without wet wraps. Both applied emollient twice daily and as necessary. The primary outcome measure was the Six Area, Six Sign Atopic Dermatitis (SASSAD) severity score, and the secondary outcome measures were the Infants Dermatology Quality of Life Index (IDQOL), the Dermatitis Family Impact (DFI) score and the weight of topical steroids and emollients used. Over the 2-week active therapy period the mean fall in SASSAD was 8 [95% confidence interval (CI), -18 to +2; P = 0.11] more in the non-WWT group, the median change in the IDQOL was 2 for Group one and 7 for Group two (95% CI for difference, -10 to +3; P = 0.24) and the median change in DFI score was 2 for Group one and 5 for Group two (95% CI for difference, -14 to +2; P = 0.42). This small study has shown that conventional therapy with HC and emollients alone is as effective as WWT for infants with moderately severe, widespread AD, and provides weak evidence to suggest that it may be more effective. We would not advocate routine use of WWT for moderate eczema without further evaluation. PMID:15245526

  17. Prevalence of childhood asthma, rhinitis and eczema in Scandinavia and Eastern Europe.

    PubMed

    Björkstén, B; Dumitrascu, D; Foucard, T; Khetsuriani, N; Khaitov, R; Leja, M; Lis, G; Pekkanen, J; Priftanji, A; Riikjärv, M A

    1998-08-01

    There is evidence that the prevalence of allergies and asthma differs between populations in western and eastern Europe. This study investigated the prevalence of wheezing, rhinitis and eczema among schoolchildren in urban and rural areas of Scandinavia and the formerly socialist countries of Eastern Europe. A total of 79,000 children from two age groups (13-14 yrs and 6-7 yrs) in 18 study centres responded to a questionnaire within the International Study of Asthma and Allergy in Children (ISAAC). The 12 month period prevalence of symptoms of asthma, allergic rhinoconjunctivitis and atopic eczema was calculated. The prevalence of wheezing among the 13-14 yr old children was 11.2-19.7% in Finland and Sweden, 7.6-8.5% in Estonia, Latvia and Poland and 2.6-5.9% in Albania, Romania, Russia, Georgia and Uzbekistan (except Samarkand). The prevalence of itching eyes and flexural dermatitis varied in a similar manner between the three regions. The regional differences were less pronounced among the 6-7 yr old children in the seven participating centres. The highest prevalence of rhinitis was recorded in April-July in Scandinavia and during the winter months in the other countries. The prevalence of atopy-related disorders was higher in Scandinavia than in Estonia, Latvia and Poland, which in turn had a higher prevalence than five other countries of eastern Europe with a culture less similar to western Europe. This supports the hypothesis that "Western life style" is associated with a high prevalence of childhood allergy. PMID:9727797

  18. Genomic Insights into the Atopic Eczema-Associated Skin Commensal Yeast Malassezia sympodialis

    PubMed Central

    Gioti, Anastasia; Nystedt, Björn; Li, Wenjun; Xu, Jun; Andersson, Anna; Averette, Anna F.; Münch, Karin; Wang, Xuying; Kappauf, Catharine; Kingsbury, Joanne M.; Kraak, Bart; Walker, Louise A.; Johansson, Henrik J.; Holm, Tina; Lehtiö, Janne; Stajich, Jason E.; Mieczkowski, Piotr; Kahmann, Regine; Kennell, John C.; Cardenas, Maria E.; Lundeberg, Joakim; Saunders, Charles W.; Boekhout, Teun; Dawson, Thomas L.; Munro, Carol A.; de Groot, Piet W. J.; Butler, Geraldine; Heitman, Joseph; Scheynius, Annika

    2013-01-01

    ABSTRACT Malassezia commensal yeasts are associated with a number of skin disorders, such as atopic eczema/dermatitis and dandruff, and they also can cause systemic infections. Here we describe the 7.67-Mbp genome of Malassezia sympodialis, a species associated with atopic eczema, and contrast its genome repertoire with that of Malassezia globosa, associated with dandruff, as well as those of other closely related fungi. Ninety percent of the predicted M. sympodialis protein coding genes were experimentally verified by mass spectrometry at the protein level. We identified a relatively limited number of genes related to lipid biosynthesis, and both species lack the fatty acid synthase gene, in line with the known requirement of these yeasts to assimilate lipids from the host. Malassezia species do not appear to have many cell wall-localized glycosylphosphatidylinositol (GPI) proteins and lack other cell wall proteins previously identified in other fungi. This is surprising given that in other fungi these proteins have been shown to mediate interactions (e.g., adhesion and biofilm formation) with the host. The genome revealed a complex evolutionary history for an allergen of unknown function, Mala s 7, shown to be encoded by a member of an amplified gene family of secreted proteins. Based on genetic and biochemical studies with the basidiomycete human fungal pathogen Cryptococcus neoformans, we characterized the allergen Mala s 6 as the cytoplasmic cyclophilin A. We further present evidence that M. sympodialis may have the capacity to undergo sexual reproduction and present a model for a pseudobipolar mating system that allows limited recombination between two linked MAT loci. PMID:23341551

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

    PubMed

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

    2014-07-01

    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

  20. Methicillin-resistant Staphylococcus aureus (MRSA) nasal real-time PCR: a predictive tool for contamination of the hospital environment.

    PubMed

    Livorsi, Daniel J; Livorsi, David J; Arif, Sana; Garry, Patricia; Kundu, Madan G; Satola, Sarah W; Davis, Thomas H; Batteiger, Byron; Kressel, Amy B

    2015-01-01

    OBJECTIVE We sought to determine whether the bacterial burden in the nares, as determined by the cycle threshold (CT) value from real-time MRSA PCR, is predictive of environmental contamination with MRSA. METHODS Patients identified as MRSA nasal carriers per hospital protocol were enrolled within 72 hours of room admission. Patients were excluded if (1) nasal mupirocin or chlorhexidine body wash was used within the past month or (2) an active MRSA infection was suspected. Four environmental sites, 6 body sites and a wound, if present, were cultured with premoistened swabs. All nasal swabs were submitted for both a quantitative culture and real-time PCR (Roche Lightcycler, Indianapolis, IN). RESULTS At study enrollment, 82 patients had a positive MRSA-PCR. A negative correlation of moderate strength was observed between the CT value and the number of MRSA colonies in the nares (r=-0.61; P<0.01). Current antibiotic use was associated with lower levels of MRSA nasal colonization (CT value, 30.2 vs 27.7; P<0.01). Patients with concomitant environmental contamination had a higher median log MRSA nares count (3.9 vs 2.5, P=0.01) and lower CT values (28.0 vs 30.2; P<0.01). However, a ROC curve was unable to identify a threshold MRSA nares count that reliably excluded environmental contamination. CONCLUSIONS Patients with a higher burden of MRSA in their nares, based on the CT value, were more likely to contaminate their environment with MRSA. However, contamination of the environment cannot be predicted solely by the degree of MRSA nasal colonization. PMID:25627759

  1. ST9 MRSA strains carrying a variant of type IX SCCmec identified in the Thai community

    PubMed Central

    2013-01-01

    Background Infections caused by methicillin-resistant Staphylococcus aureus (MRSA) in Thailand occur most frequently in healthcare facilities. However, reports of community-associated MRSA are limited. Methods We characterized 14 MRSA isolates from outpatients (O-1 to O-14) by phenotypic and genotypic methods and compared them with 5 isolates from inpatients (I-1 to I-5). Thai MRSA isolates from a healthcare worker (N-1) and a pig (P-1) were also included as ST9 MRSA strains from other sources. Results All MRSA isolates from the outpatients and inpatients were multidrug-resistant (resistant to ≥3 classes of antimicrobials). All of them except strains O-2 and I-3 carried type III SCCmec and belonged to agrI, coagulase IV, spa type t037 or t233, which related to ST239. The strain O-2 (JCSC6690) carried type IX SCCmec and belonged to agrII, coagulaseXIc, spa type t337 and ST9, whereas the strain I-3 carried a type III SCCmec and belonged to ST1429. Nucleotide sequence determination revealed that the type IX SCCmec element in strain O-2 was distinct from that in a Thai ST398 strain (JCSC6943) previously identified in 2011; nucleotide identities of ccrA and ccrB were 93 and 91%, respectively and several open reading frames (ORFs) at the joining regions were different. PCR experiments suggested that strain O-2 and N-1 carried similar SCCmec element, whereas that of strain P-1 was different, suggesting that distinct ST9-MRSA–IX clones might be spreading in this province. Conclusions The SCCmecIX-ST9 MRSA clones of distinct SCCmec subtypes might have emerged in the Thai community and might also have disseminated into the hospital. PMID:23663295

  2. High prevalence of nasal MRSA carriage in slaughterhouse workers in contact with live pigs in The Netherlands.

    PubMed

    Van Cleef, B A G L; Broens, E M; Voss, A; Huijsdens, X W; Zchner, L; Van Benthem, B H B; Kluytmans, J A J W; Mulders, M N; Van De Giessen, A W

    2010-05-01

    Livestock-associated MRSA has been found in various animals, livestock farmers and retail meat. This study aimed to determine the prevalence and determinants of nasal MRSA carriage in pig slaughterhouse workers. Three large pig slaughterhouses in The Netherlands were studied in 2008 using human and environmental samples. The overall prevalence of nasal MRSA carriage in employees of pig slaughterhouses was 5.6% (14/249) (95% CI 3.4-9.2) and working with live pigs was the single most important factor for being MRSA positive (OR 38.2, P<0.0001). At the start of the day MRSA was only found in environmental samples from the lairages (10/12), whereas at the end of the day MRSA was found in the lairages (11/12), the dirty (5/12) and clean (3/12) areas and green offal (1/3). The MRSA status of the environmental samples correlated well with the MRSA status of humans working in these sections (r=0.75). In conclusion, a high prevalence of nasal MRSA carriage was found in pig-slaughterhouse workers, and working with live pigs is the most important risk factor. Exact transmission routes from animals to humans remain to be elucidated in order to enable application of targeted preventive measures. PMID:20141647

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

    PubMed Central

    2013-01-01

    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. PMID:23773484

  4. Emodin is identified as the active component of ether extracts from Rhizoma Polygoni Cuspidati, for anti-MRSA activity.

    PubMed

    Cao, Feng; Peng, Wei; Li, Xiaoli; Liu, Ming; Li, Bin; Qin, Rongxin; Jiang, Weiwei; Cen, Yanyan; Pan, Xichun; Yan, Zifei; Xiao, Kangkang; Zhou, Hong

    2015-06-01

    This study investigated the anti-methicillin-resistant Staphylococcus aureus (anti-MRSA) activity and chemical compositions of ether extracts from Rhizoma Polygoni Cuspidati (ET-RPC). Significant anti-MRSA activities of ET-RPC against MRSA252 and MRSA clinical strains were tested in in vitro antibacterial experiments, such as inhibition zone diameter test, minimal inhibitory concentration test, and dynamic bacterial growth assay. Subsequently, 7 major compounds of ET-RPC were purified and identified as polydatin, resveratrol-4-O-d-(6'-galloyl)-glucopyranoside, resveratrol, torachryson-8-O-glucoside, emodin-8-O-glucoside, 6-hydroxy-emodin, and emodin using liquid chromatography - electrospray ionization - tandem mass spectrometry. After investigation of anti-MRSA activities of the 7 major compounds, only emodin had significant anti-MRSA activity. Further, transmission electron microscopy was used to observe morphological changes in the cell wall of MRSA252, and the result revealed that emodin could damage the integrity of cell wall, leading to loss of intracellular components. In summary, our results showed ET-RPC could significantly inhibit bacterial growth of MRSA strains. Emodin was identified as the major compound with anti-MRSA activity; this activity was related to destruction of the integrity of the cell wall and cell membrane. PMID:25966789

  5. Report from the third international consensus meeting to harmonise core outcome measures for atopic eczema/dermatitis clinical trials (HOME)

    PubMed Central

    Chalmers, JR; Schmitt, J; Apfelbacher, C; Dohil, M; Eichenfield, LF; Simpson, EL; Singh, J; Spuls, P; Thomas, KS; Admani, S; Aoki, V; Ardeleanu, M; Barbarot, S; Berger, T; Bergman, JN; Block, J; Borok, N; Burton, T; Chamlin, SL; Deckert, S; DeKlotz, CC; Graff, LB; Hanifin, JM; Hebert, AA; Humphreys, R; Katoh, N; Kisa, RM; Margolis, DJ; Merhand, S; Minnillo, R; Mizutani, H; Nankervis, H; Ohya, Y; Rodgers, P; Schram, ME; Stalder, JF; Svensson, A; Takaoka, R; Teper, A; Tom, WL; von Kobyletzki, L; Weisshaar, E; Zelt, S; Williams, HC

    2014-01-01

    Summary This report provides a summary of the third meeting of the Harmonising Outcome Measures for Eczema (HOME) initiative held in San Diego, CA, U.S.A., 6–7 April 2013 (HOME III). The meeting addressed the four domains that had previously been agreed should be measured in every eczema clinical trial: clinical signs, patient-reported symptoms, long-term control and quality of life. Formal presentations and nominal group techniques were used at this working meeting, attended by 56 voting participants (31 of whom were dermatologists). Significant progress was made on the domain of clinical signs. Without reference to any named scales, it was agreed that the intensity and extent of erythema, excoriation, oedema/papulation and lichenification should be included in the core outcome measure for the scale to have content validity. The group then discussed a systematic review of all scales measuring the clinical signs of eczema and their measurement properties, followed by a consensus vote on which scale to recommend for inclusion in the core outcome set. Research into the remaining three domains was presented, followed by discussions. The symptoms group and quality of life groups need to systematically identify all available tools and rate the quality of the tools. A definition of long-term control is needed before progress can be made towards recommending a core outcome measure. What's already known about this topic? Many different scales have been used to measure eczema, making it difficult to compare trials in meta-analyses and hampering improvements in clinical practice. HOME core outcome measures must pass the OMERACT (Outcome Measures in Rheumatology) filter of truth (validity), discrimination (sensitivity to change and responsiveness) and feasibility (ease of use, costs, time to perform and interpret). It has been previously agreed as part of the consensus process that four domains should be measured by the core outcomes: clinical signs, patient-reported symptoms, long-term control and health-related quality of life. What does this study add? Progress was made towards developing a core outcome set for measuring eczema in clinical trials. The group established the essential items to be included in the outcome measure for the clinical signs of eczema and was able to recommend a scale for the core set. The remaining three domains of patient-reported symptoms, long-term control and health-related quality of life require further work and meetings to determine the core outcome measures. PMID:24980543

  6. Eradication of a mature methicillin-resistant Staphylococcus aureus (MRSA) biofilm from acrylic surfaces.

    PubMed

    Altieri, Karen Tereza; Sanitá, Paula Volpato; Machado, Ana Lucia; Giampaolo, Eunice Teresinha; Pavarina, Ana Cláudia; Jorge, Janaina Habib; Vergani, Carlos Eduardo

    2013-01-01

    Methicillin-resistant Staphylococcus aureus (MRSA) can grow as structured biofilm in different surfaces, including oral mucosa and denture surfaces. Such biofilms can be released into the oral fluids and aspirated, causing systemic infections such as aspiration pneumonia. This study evaluated the efficacy of two disinfectant solutions and microwave irradiation in disinfecting acrylic specimens contaminated with MRSA biofilm. Thirty-six acrylic specimens were made, sterilized and contaminated with MRSA (107 cfu/mL). After incubation (37 °C/48 h), the specimens were divided into 4 groups: not disinfected (positive control); soaking in 1% sodium hypochlorite for 10 min; soaking in 2% chlorhexidine gluconate for 10 min; and irradiating by microwave for 3 min at 650 W. The viability of cells was evaluated by XTT reduction method. All specimens from the positive control group showed biofilm formation after 48 h incubation. The mean absorbance value of the control specimens was 1.58 (OD at 492 nm). No evidence of biofilm formation was observed on specimens after the disinfection methods. Disinfection by soaking in 1% sodium hypochlorite and 2% chlorhexidine gluconate and irradiating by microwaves resulted in 100% reduction of MRSA biofilm metabolism. The use of chemical solutions and microwave irradiation was shown to be effective for eradicating mature MRSA biofilms on acrylic resin specimens. PMID:24474290

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

    PubMed

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

    2012-12-01

    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 (10μg 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

  8. Prevalence of Staphylococcus aureus and methicillin-resistant Staphylococcus aureus (MRSA) on retail meat in Iowa.

    PubMed

    Hanson, B M; Dressler, A E; Harper, A L; Scheibel, R P; Wardyn, S E; Roberts, L K; Kroeger, J S; Smith, T C

    2011-09-01

    Several recent studies have indicated a high prevalence of methicillin-resistant Staphylococcus aureus (MRSA) in retail-available meat. However, few studies have investigated MRSA in meat in the United States. The aim of this study was to determine the presence of Staphylococcus aureus (S. aureus) on meat samples available at retail stores. Samples of fresh raw pork, chicken, beef, and turkey were purchased from 22 food stores throughout Iowa. S. aureus strains were isolated from 27 of 165 samples, giving an overall prevalence of 16.4%. Turkey, pork, chicken, and beef had individual S. aureus prevalence rates of 19.4%, 18.2%, 17.8%, and 6.9%, respectively. Two isolates of MRSA were isolated from pork, giving an overall prevalence of 1.2%. One MRSA isolate was positive for the PVL gene. Common spa types included t034, t337, t008, and t002. These results suggest that MRSA is present on low numbers of retail meat in Iowa. PMID:22000843

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

    PubMed Central

    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

    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 μg/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 β-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 (β-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. PMID:24319486

  10. Quorum Quenching and Antimicrobial Activity of Goldenseal (Hydrastis canadensis) against Methicillin-Resistant Staphylococcus aureus (MRSA)

    PubMed Central

    Cech, Nadja B.; Junio, Hiyas A.; Ackermann, Laynez W.; Kavanaugh, Jeffrey S.; Horswill, Alexander R.

    2015-01-01

    The popular herbal remedy goldenseal (Hydrastis canadensis L.) is traditionally used to treat skin infections. With this study, we show activity of H. canadensis extracts in vitro against methicillin-resistant Staphylococcus aureus (MRSA). An extract from H. canadensis leaves demonstrated more potent antimicrobial activity than the alkaloid berberine alone (MICs of 75 g/mL and 150 g/mL, respectively). LC-MS detected alkaloids and efflux-pump inhibitory flavonoids in the extract, and the latter may explain the enhanced efficacy of the extract compared to berberine alone. We also show evidence of anti-virulence activity as a second mechanism by which H. canadensis acts against S. aureus. The H. canadensis leaf extract (but not the isolated alkaloids berberine, hydrastine, and canadine) demonstrated quorum quenching activity against several clinically relevant MRSA isolates (USA300 strains). Our data suggest that this occurs by attenuation of signal transduction through the AgrCA two-component system. Consistent with this observation, the extract inhibited toxin production by MRSA, and prevented damage by MRSA to keratinocyte cells in vitro. Collectively, our results show that H. canadensis leaf extracts possess a mixture of constituents that act against MRSA via several different mechanisms. These findings lend support for the traditional application of crude H. canadensis extracts in the treatment of prevention of infection. PMID:22814821

  11. MRSA from Santa Catarina State, Southern Brazil: intriguing epidemiological differences compared to other Brazilian regions.

    PubMed

    Silveira, Alessandro C O; Cunha, Gabriela R; Caierão, Juliana; Cordova, Caio M de; d'Azevedo, Pedro A

    2015-01-01

    Methicillin-resistant Staphylococcus aureus (MRSA) is one of the most frequently isolated agents in both nosocomial and community settings. It is a constant challenge for antibacterial therapy. Therefore, it becomes essential to understand the epidemiology of MRSA isolates in the institution and/or region to guide empirical therapy. The objective of this study was to evaluate the epidemiological characteristics of MRSA isolates in the state of Santa Catarina, Brazil, and determine if there is a clonal spread. We evaluated 124 clinical isolates of MRSA obtained from various anatomical sites from patients in the state of Santa Catarina in Southern Brazil. The antimicrobial susceptibility profile was evaluated by disk diffusion and minimum inhibitory concentration (MIC) was determined by Etest and broth macrodilution. SCCmec types were determined by multiplex PCR and the clonal relationship among isolates was assessed by pulsed field gel electrophoresis. Antimicrobials that have demonstrated lower rates of resistance were tetracycline (20.2%), sulfamethoxazole-trimethoprim (20.2%) and chloramphenicol (12.9%). We did not detect any resistance to glycopeptides, daptomycin, linezolid, and tigecycline. SCCmec type III was predominant (54%), followed by type II (21.8%), consistent with other Brazilian studies. Twenty-six clones were observed grouping 72 (58%) isolates and no clonal relationship was observed between our isolates and the major epidemic clones circulating in Brazil. An intriguing distinct MRSA epidemiology was observed in Santa Catarina, compared to other Brazilian regions. PMID:26119853

  12. Transmission rates, screening methods and costs of MRSA--a systematic literature review related to the prevalence in Germany.

    PubMed

    Tübbicke, A; Hübner, C; Kramer, A; Hübner, N-O; Fleßa, S

    2012-10-01

    Methicillin-resistant Staphylococcus aureus (MRSA) infections represent a serious challenge for health care institutions, which is inherent in the combination of prevalence, transmission rates and costs. Furthermore, performing an MRSA screening requires information on the complex system of effectiveness, accuracy and costs of different screening methods. The purpose of this study was to give an overview of parameters with decisive significance for the burden of MRSA and the selection of a specific MRSA screening strategy. A systematic literature search for peer-reviewed health economic studies associated with MRSA was performed (from 1995 to the present). Eighty-seven different studies met all inclusion and exclusion criteria. Primary outcomes included the prevalence of MRSA, MRSA transmission rates, performance characteristics of MRSA screening methods, costs for pre-emptive isolation precautions and costs per MRSA case. The prevalence rates reported for all inpatients (1.2-5.3 %) as well as for inpatients with risk factors or patients in risk areas (3.85-20.6 %) vary greatly. The range of cross-transmission rates per day reported for patients with MRSA in isolation is 0.00081-0.009 and for carriers not in isolation is 0.00137-0.140, respectively. For polymerase chain reaction (PCR) methods, the mean sensitivity and specificity were 91.09 and 95.79 %, respectively. Culture methods show an average sensitivity of 89.01 % and an average specificity of 93.21 %. The turn-around time for PCR methods averages 15 h, while for the culture method, it can only be estimated as 48-72 h. This review filtered important parameters and cost drivers, and covered them with literature-based averages. These findings serve as an ideal evidence base for further health economic considerations of the cost-effectiveness of different MRSA screening methods. PMID:22573360

  13. Tackling contamination of the hospital environment by methicillin-resistant Staphylococcus aureus (MRSA): a comparison between conventional terminal cleaning and hydrogen peroxide vapour decontamination.

    PubMed

    French, G L; Otter, J A; Shannon, K P; Adams, N M T; Watling, D; Parks, M J

    2004-05-01

    The hospital environment can sometimes harbour methicillin-resistant Staphylococcus aureus (MRSA) but is not generally regarded as a major source of MRSA infection. We conducted a prospective study in surgical wards of a London teaching hospital affected by MRSA, and compared the effectiveness of standard cleaning with a new method of hydrogen peroxide vapour decontamination. MRSA contamination, measured by surface swabbing was compared before and after terminal cleaning that complied with UK national standards, or hydrogen peroxide vapour decontamination. All isolation rooms, ward bays and bathrooms tested were contaminated with MRSA and several antibiogram types were identified. MRSA was common in sites that might transfer organisms to the hands of staff and was isolated from areas and bed frames used by non-MRSA patients. Seventy-four percent of 359 swabs taken before cleaning yielded MRSA, 70% by direct plating. After cleaning, all areas remained contaminated, with 66% of 124 swabs yielding MRSA, 74% by direct plating. In contrast, after exposing six rooms to hydrogen peroxide vapour, only one of 85 (1.2%) swabs yielded MRSA, by enrichment culture only. The hospital environment can become extensively contaminated with MRSA that is not eliminated by standard cleaning methods. In contrast, hydrogen peroxide vapour decontamination is a highly effective method of eradicating MRSA from rooms, furniture and equipment. Further work is needed to determine the importance of environmental contamination with MRSA and the effect on hospital infection rates of effective decontamination. PMID:15142713

  14. Environmental tobacco smoke and the risk of eczema symptoms among school children in South Africa: a cross-sectional study

    PubMed Central

    Shirinde, Joyce; Wichmann, Janine; Voyi, Kuku

    2015-01-01

    Objective The aim of this study was to investigate the association between eczema ever (EE) and current eczema symptoms (ES) in relation to exposure to environmental tobacco smoke (ETS). Design A cross-sectional study using the International Study of Asthma and Allergies in Childhood questionnaire. Setting 16 schools were randomly selected from two neighbourhoods situated in Ekurhuleni Metropolitan Municipality, Gauteng Province, South Africa. Participants From a total population of 3764 school children aged 12–14 years, 3468 completed the questionnaire (92% response rate). A total of 3424 questionnaires were included in the final data analysis. Primary outcome The prevalence of EE and current ES was the primary outcome in this study. Results Data were analysed using Multilevel Logistic Regression Analysis (MLRA). The likelihood of EE was increased by exposure to ETS at home (OR 1.30 95% CI 1.01 to 1.67) and at school (OR 1.26 95% CI 1.00 to 1.60). The likelihood of EE was lower for males (OR 0.66 95% CI 0.51 to 0.84). The likelihood of ES was increased by ETS at home (OR 1.93 95% CI 1.43 to 2.59) and school (1.44 95% CI 1.09 to 1.90). The likelihood of ES was again lower for males (OR 0.56 95% CI 0.42 to 0.76). Smoking by mother/female guardian increased the likelihood of EE and ES, however, this was not significant in the multivariate analysis. Conclusions Symptoms of eczema were positively associated with exposure to ETS at home and school. The results support the hypothesis that ETS is an important factor in understanding the occurrence of eczema. PMID:26310401

  15. [Pili trianguli et canaliculi. A case report of uncombable hair in relation to atopic eczema and tooth anomalies].

    PubMed

    Beringer, K; Botzi, C; Hemmer, W; Focke, M; Götz, M; Jarisch, R

    2000-04-01

    We report on a child with pili trianguli et canaliculi. This hair shaft abnormality belongs to a heterogeneous group of diseases which are included under the synonym uncombable hair. The diagnosis was confirmed by scanning electron microscopy, revealing hair shafts with a characteristic longitudinal groove. In addition the girl suffered from atopic eczema and tooth anomalies. Our findings suggest that this disorder could represent a tricho-odontal subtype of ectodermal dysplasia. PMID:10810664

  16. Rapid Detection of Staphylococcus aureus and Methicillin-Resistant S. aureus (MRSA) in Wound Specimens and Blood Cultures: Multicenter Preclinical Evaluation of the Cepheid Xpert MRSA/SA Skin and Soft Tissue and Blood Culture Assays▿

    PubMed Central

    Wolk, D. M.; Struelens, M. J.; Pancholi, P.; Davis, T.; Della-Latta, P.; Fuller, D.; Picton, E.; Dickenson, R.; Denis, O.; Johnson, D.; Chapin, K.

    2009-01-01

    A multicenter preclinical evaluation was conducted to evaluate the performance of two Cepheid Xpert assays for detection of methicillin-resistant Staphylococcus aureus (MRSA) and S. aureus. Sensitivity was 97.1% and 98.3% for MRSA in wound and blood culture specimens, respectively. Sensitivity was 100% for S. aureus from both specimen types. PMID:19144803

  17. Detection of methicillin resistant Staphylococcus aureus (MRSA) from recreational beach using the mecA gene

    NASA Astrophysics Data System (ADS)

    Zulkifli, Aisya; Ahmad, Asmat

    2015-09-01

    Water samples were collected in triplicates from three different locations choosen from the recreational beach of Teluk Kemang, Port Dickson as sampling station including main area of recreation activity for the public. Bacteria were isolated from the water and cultured. Out of 286 presumptive Staphylococcus aureus enumerated by using culture method, only 4 (1.4 %) confirmed as Meticillin Resistant S. aureus (MRSA) based on PCR detection of mecA gene. Interestingly, all of MRSA detections were found at the main area of recreational activity. Our results suggested that public beaches may be reservoir for transmission of MRSA to beach visitors and PCR using the mecA gene is the fastest way to detect this pathogenic bacteria.

  18. From bone to heart: a case of MRSA osteomyelitis with haematogenous spread to the pericardium.

    PubMed

    Dherange, Parinita A; Patel, Sarah; Enakpene, Evbu; Suryanarayana, Prakash

    2015-01-01

    We report a case of a 55-year-old woman with a history of type 2 diabetes mellitus, Charcot arthropathy and end-stage renal disease, who presented with a syncopal episode after undergoing haemodialysis. She had a history of methicillin-resistant Staphylococcus aureus (MRSA) bacteraemia from an unknown source 3 months earlier, which was treated with an 8-week course of intravenous antibiotics. At the time of presentation to the emergency room, she was found to be in refractory shock. Bedside echocardiogram was performed, which showed moderate pericardial effusion. The effusion was later found to be due to MRSA, which was identified in blood and in pericardial fluid cultures. The patient was successfully treated with intravenous daptomycin for 6 weeks. Acute osteomyelitis of her right foot was the source of the MRSA, for which a right below-knee amputation was ultimately performed. PMID:26643184

  19. Contact Hypersensitivity to European Baseline Series and Corticosteroid Series Haptens in a Population of Adult Patients with Contact Eczema.

    PubMed

    Kot, Marek; Bogaczewicz, Jarosław; Kręcisz, Beata; Woźniacka, Anna

    2016-04-01

    Contact eczema (CE) is one of the most common skin diseases and is regarded as a reaction pattern. However, the skin can react in the same way to different stimuli, some of which may act together. The golden standard in the diagnosis of allergic contact dermatitis (ACD) is the patch test. Contact allergy to topical corticosteroids is known to be gradually rising, and this represents a significant problem in the treatment of contact eczema. The aim of this study was to evaluate the prevalence of contact allergy to European Baseline Series and Corticosteroid Series haptens in a population of patients with CE. A group of 126 patients with the clinical diagnosis of contact eczema were patch tested with 28 European Baseline Series allergens and 8 corticosteroid allergens in different concentrations and in different media: 80 (64.5%) women and 46 (36.5%) men, mean age 50.4 years. The average duration of CE was 6.9 years. In total, 65 patients (51.6%) demonstrated an allergic reaction to at least one European Baseline Series allergen, and 22 patients (17.4%) to at least one corticosteroid. The most common allergens giving positive results were nickel sulfate (26.2%), cobalt chloride (15.1%), budesonide (14.3%), potassium dichromate (13.5%), and myroxylon pereirae resin (MPR) (11.9%). According our data, the European Baseline Series tests allow the cause of ACD to be identified in over 50% of cases. PMID:27149128

  20. Report from the third international consensus meeting to harmonise core outcome measures for atopic eczema/dermatitis clinical trials (HOME).

    PubMed

    Chalmers, J R; Schmitt, J; Apfelbacher, C; Dohil, M; Eichenfield, L F; Simpson, E L; Singh, J; Spuls, P; Thomas, K S; Admani, S; Aoki, V; Ardeleanu, M; Barbarot, S; Berger, T; Bergman, J N; Block, J; Borok, N; Burton, T; Chamlin, S L; Deckert, S; DeKlotz, C C; Graff, L B; Hanifin, J M; Hebert, A A; Humphreys, R; Katoh, N; Kisa, R M; Margolis, D J; Merhand, S; Minnillo, R; Mizutani, H; Nankervis, H; Ohya, Y; Rodgers, P; Schram, M E; Stalder, J F; Svensson, A; Takaoka, R; Teper, A; Tom, W L; von Kobyletzki, L; Weisshaar, E; Zelt, S; Williams, H C

    2014-12-01

    This report provides a summary of the third meeting of the Harmonising Outcome Measures for Eczema (HOME) initiative held in San Diego, CA, U.S.A., 6-7 April 2013 (HOME III). The meeting addressed the four domains that had previously been agreed should be measured in every eczema clinical trial: clinical signs, patient-reported symptoms, long-term control and quality of life. Formal presentations and nominal group techniques were used at this working meeting, attended by 56 voting participants (31 of whom were dermatologists). Significant progress was made on the domain of clinical signs. Without reference to any named scales, it was agreed that the intensity and extent of erythema, excoriation, oedema/papulation and lichenification should be included in the core outcome measure for the scale to have content validity. The group then discussed a systematic review of all scales measuring the clinical signs of eczema and their measurement properties, followed by a consensus vote on which scale to recommend for inclusion in the core outcome set. Research into the remaining three domains was presented, followed by discussions. The symptoms group and quality of life groups need to systematically identify all available tools and rate the quality of the tools. A definition of long-term control is needed before progress can be made towards recommending a core outcome measure. PMID:24980543

  1. Seasonality in symptom severity influenced by temperature or grass pollen: results of a panel study in children with eczema.

    PubMed

    Krämer, Ursula; Weidinger, Stephan; Darsow, Ulf; Möhrenschlager, Matthias; Ring, Johannes; Behrendt, Heidrun

    2005-03-01

    Although seasonal variations are well known in many patients with eczema, no systematic population-based panel study evaluating seasonality and quantifying the influence of factors like climate and pollen on symptom variations has been conducted so far. Thirty-nine children with eczema, who had been identified in 1996 in a cross-sectional study on 1673 6-y-olds in Augsburg (Germany), participated in the study. Between March and September 1999, they daily recorded itch, extent, and possibly triggering factors on quantitative scales. Daily temperature, humidity, radiation, and pollen concentration were measured. Mixed linear models, taking the time series structure and confounding into account, were used for analysis. Seasonal patterns were significantly different between children: twenty-one had symptoms mainly in winter. They were affected by changes in outdoor temperature: itch was reduced by 22% (95% confidence interval (CI): 16%-27%) and extent by 65% (CI: 54%-72%) per 15 degrees C temperature increase. Eighteen children exhibited more symptoms in summer and especially during days with high grass-pollen exposure when itch was 16% higher (CI: 8%-24%) and extent 19% (CI: 2%-39%). This effect was stronger for children sensitized against pollen. Consideration of the individual type of eczema may help to arrange appropriate preventive and therapeutic measures. PMID:15737191

  2. Effects of Subinhibitory Concentrations of Ceftaroline on Methicillin-Resistant Staphylococcus aureus (MRSA) Biofilms.

    PubMed

    Lázaro-Díez, María; Remuzgo-Martínez, Sara; Rodríguez-Mirones, Cristina; Acosta, Felix; Icardo, Jose M; Martínez-Martínez, Luis; Ramos-Vivas, José

    2016-01-01

    Ceftaroline (CPT) is a novel cephalosporin with in vitro activity against Staphylococcus aureus. Ceftaroline exhibits a level of binding affinity for PBPs in S. aureus including PBP2a of methicillin-resistant S. aureus (MRSA). The aims of this study were to investigate the morphological, physiological and molecular responses of MRSA clinical strains and MRSA biofilms to sub-MICs (1/4 and 1/16 MIC) of ceftaroline by using transmission, scanning and confocal microscopy. We have also used quantitative Real-Time PCR to study the effect of sub-MICs of ceftaroline on the expression of the staphylococcal icaA, agrA, sarA and sasF genes in MRSA biofilms. In one set of experiments, ceftaroline was able to inhibit biofilm formation in all strains tested at MIC, however, a strain dependent behavior in presence of sub-MICs of ceftaroline was shown. In a second set of experiments, destruction of preformed biofilms by addition of ceftaroline was evaluated. Ceftaroline was able to inhibit biofilm formation at MIC in all strains tested but not at the sub-MICs. Destruction of preformed biofilms was strain dependent because the biofilm formed by a matrix-producing strain was resistant to a challenge with ceftaroline at MIC, whereas in other strains the biofilm was sensitive. At sub-MICs, the impact of ceftaroline on expression of virulence genes was strain-dependent at 1/4 MIC and no correlation between ceftaroline-enhanced biofilm formation and gene regulation was established at 1/16 MIC. Our findings suggest that sub-MICs of ceftaroline enhance bacterial attachment and biofilm formation by some, but not all, MRSA strains and, therefore, stress the importance of maintaining effective bactericidal concentrations of ceftaroline to fight biofilm-MRSA related infections. PMID:26800524

  3. Effects of Subinhibitory Concentrations of Ceftaroline on Methicillin-Resistant Staphylococcus aureus (MRSA) Biofilms

    PubMed Central

    Rodríguez-Mirones, Cristina; Acosta, Felix; Icardo, Jose M.; Martínez-Martínez, Luis; Ramos-Vivas, José

    2016-01-01

    Ceftaroline (CPT) is a novel cephalosporin with in vitro activity against Staphylococcus aureus. Ceftaroline exhibits a level of binding affinity for PBPs in S. aureus including PBP2a of methicillin-resistant S. aureus (MRSA). The aims of this study were to investigate the morphological, physiological and molecular responses of MRSA clinical strains and MRSA biofilms to sub-MICs (1/4 and 1/16 MIC) of ceftaroline by using transmission, scanning and confocal microscopy. We have also used quantitative Real-Time PCR to study the effect of sub-MICs of ceftaroline on the expression of the staphylococcal icaA, agrA, sarA and sasF genes in MRSA biofilms. In one set of experiments, ceftaroline was able to inhibit biofilm formation in all strains tested at MIC, however, a strain dependent behavior in presence of sub-MICs of ceftaroline was shown. In a second set of experiments, destruction of preformed biofilms by addition of ceftaroline was evaluated. Ceftaroline was able to inhibit biofilm formation at MIC in all strains tested but not at the sub-MICs. Destruction of preformed biofilms was strain dependent because the biofilm formed by a matrix-producing strain was resistant to a challenge with ceftaroline at MIC, whereas in other strains the biofilm was sensitive. At sub-MICs, the impact of ceftaroline on expression of virulence genes was strain-dependent at 1/4 MIC and no correlation between ceftaroline-enhanced biofilm formation and gene regulation was established at 1/16 MIC. Our findings suggest that sub-MICs of ceftaroline enhance bacterial attachment and biofilm formation by some, but not all, MRSA strains and, therefore, stress the importance of maintaining effective bactericidal concentrations of ceftaroline to fight biofilm-MRSA related infections. PMID:26800524

  4. The nasal vestibulum is the optimal sampling site for MRSA screening in hospitalised horses.

    PubMed

    Van den Eede, A; Hermans, K; Van den Abeele, A; Floré, K; Dewulf, J; Vanderhaeghen, W; Némeghaire, S; Butaye, P; Gasthuys, F; Haesebrouck, F; Martens, A

    2013-08-01

    The increased incidence of methicillin-resistant Staphylococcus aureus (MRSA) infection in equine hospitals highlights the need for infection control protocols based on optimal patient screening. In horses, the deep ventral meatus of the nasal cavity is the principal site sampled to detect MRSA. However, in humans, the anterior nares are the preferred sampling site. The objective of this study was to determine the optimal sampling location in the nasal chambers for MRSA in horses by comparing the results obtained from three different locations (the vestibulum, diverticulum and ventral meatus) in 240 hospitalised animals. Antimicrobial susceptibility testing and epidemiological typing were conducted on representative subsets of the isolates obtained. Compared to the more invasive ventral meatus sampling (relative sensitivity 68.9%; isolation rate 37.9%), vestibulum (RS 81.1%; IR 44.6%, P=0.13) and diverticulum (RS 52.3%; IR 28.8%, P=0.03) sampling were more or less sensitive, respectively. In total, 132 horses (55%) were MRSA positive with the vast majority (98.5%) carrying genotyped isolates of the livestock-associated (LA)-MRSA clonal complex (CC) 398, and only a minority (1.5%) CC8. Of the 22 MLST typed isolates, five belonged to a novel ST2197 (t011, CC398). Although 93.9% of the isolates were multi-resistant (to β-lactam, tetracycline, trimethoprim, and gentamicin), <5% were resistant to virtually all antimicrobials commonly used in equine medicine. The study findings indicate that detection of MRSA in horses may be enhanced by replacing the traditional deep sampling of the ventral nasal meatus by the less invasive approach of sampling the nasal vestibulum. PMID:23465751

  5. Auxiliary factors: a chink in the armor of MRSA resistance to β-lactam antibiotics.

    PubMed

    Roemer, Terry; Schneider, Tanja; Pinho, Mariana G

    2013-10-01

    Combination agents provide an important orthogonal approach to treat infectious diseases, particularly those caused by drug resistant pathogens. Indeed, applying a biologically 'rational' and systems-level paradigm to discover potent, selective, and synergistic agents would augment current (and arguably overly relied upon) empirical and serendipitous approaches to such discovery efforts. Here, we review the cellular mechanisms of β-lactam drug resistance and tolerance achieved amongst methicillin-resistant Staphylococcus aureus (MRSA) as well as their molecular targets and strategies to identify cognate inhibitors as potential combination agents to restore β-lactam efficacy against MRSA. PMID:23895826

  6. Surveillance of methicillin-resistant Staphylococcus aureus (MRSA) in acute care hospitals. Results of the VINCat Program (2008-2010).

    PubMed

    Freixas, Núria; Sopena, Nieves; Limón, Enric; Bella, Feliu; Matas, Lourdes; Almirante, Benito; Pujol, Miquel

    2012-06-01

    Methicillin-resistant Staphylococcus aureus (MRSA) is a common cause of healthcare-related infection. Surveillance and prevention of MRSA is a priority in infection control programs. The aim of this study was to describe rates and trends of MRSA colonization or infection in 40 hospitals participating in the VINCat Program from 2008 to 2010. The study included all patients treated in acute care areas of participating hospitals. Hospitals were stratified into 3 groups based on size. The following annual indicators were reported: Methicillin-resistance rate, incidence density of new cases of MRSA and incidence density of MRSA bacteremia. Between 2008 and 2010, the yearly mean rate of resistance to methicillin remained stable for the study period (24%-25%), while the mean incidence of new cases of MRSA decreased from 0.65 to 0.54 cases per 1000 patient-days (p=NS) and the mean incidence of MRSA bacteremia decreased from 0.06 to 0.05 cases per 1,000 patient-days (p=NS). The implementation of a MRSA surveillance system in hospitals that participated in the VINCat Program provides information on the situation of each institution and facilitated interhospital comparisons in order to establish appropriate preventive measures. PMID:22776153

  7. Genotypic and phenotypic characterization of methicillin-resistant Staphylococcus aureus (MRSA) clones with high-level mupirocin resistance.

    PubMed

    González-Domínguez, María; Seral, Cristina; Potel, Carmen; Sáenz, Yolanda; Álvarez, Maximiliano; Torres, Carmen; Castillo, Francisco Javier

    2016-06-01

    A high proportion of methicillin-resistant Staphylococcus aureus isolates recovered in one year period showed high-level mupirocin-resistance (HLMUPR-MRSA) in our environment (27.2%). HLMUPR-MRSA isolates were mainly collected from skin and soft tissue samples, and diabetes was the main related comorbidity condition. These isolates were more frequently found in vascular surgery. HLMUPR-MRSA was more resistant to aminoglycosides than mupirocin-susceptible MRSA, linked to the presence of bifunctional and/or nucleotidyltransferase enzymes with/without macrolide resistance associated with the msr(A) gene. Most of HLMUPR-MRSA isolates belonged to ST125/t067. Nine IS257-ileS2 amplification patterns (p3 was the most frequent) were observed in HLMUPR-MRSA isolates, suggesting the presence of several mupirocin-resistance-carrying plasmids in our environment and promoting the emergence of mupirocin resistance. The presence of the same IS257-ileS2 amplification pattern p3 in 65% of HLMUPR-MRSA, all of them ST125/t067, suggests a clonal spread in our hospital and community environment which could explain the high prevalence of HLMUPR-MRSA during the study period. An outbreak situation or an increase in mupirocin consumption was not observed. PMID:27133306

  8. Livestock-associated methicillin-resistant Staphylococcus aureus (LA-MRSA) isolates of swine origin form robust biofilms

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Methicillin-resistant Staphylococcus aureus (MRSA) colonization of livestock animals is common and prevalence rates for pigs have been reported to be as high as 49%. One hypothesis to explain the high prevalence of MRSA in swine herds is the ability of these organisms to exist as biofilms. To invest...

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

    PubMed Central

    2014-01-01

    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 104days 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. PMID:24808943

  10. Simplified risk stratification criteria for identification of patients with MRSA bacteremia at low risk of infective endocarditis: implications for avoiding routine transesophageal echocardiography in MRSA bacteremia.

    PubMed

    Buitron de la Vega, P; Tandon, P; Qureshi, W; Nasr, Y; Jayaprakash, R; Arshad, S; Moreno, D; Jacobsen, G; Ananthasubramaniam, K; Ramesh, M; Zervos, M

    2016-02-01

    The aim of this study was to identify patients with methicillin-resistant Staphylococcus aureus (MRSA) bacteremia with low risk of infective endocarditis (IE) who might not require routine trans-esophageal echocardiography (TEE). We retrospectively evaluated 398 patients presenting with MRSA bacteremia for the presence of the following clinical criteria: intravenous drug abuse (IVDA), long-term catheter, prolonged bacteremia, intra-cardiac device, prosthetic valve, hemodialysis dependency, vertebral/nonvertebral osteomyelitis, cardio-structural abnormality. IE was diagnosed using the modified Duke criteria. Of 398 patients with MRSA bacteremia, 26.4 % of cases were community-acquired, 56.3 % were health-care-associated, and 17.3 % were hospital-acquired. Of the group, 44 patients had definite IE, 119 had possible IE, and 235 had a rejected diagnosis. Out of 398 patients, 231 were evaluated with transthoracic echocardiography (TTE) or TEE. All 44 patients with definite IE fulfilled at least one criterion (sensitivity 100 %). Finally, a receiver operator characteristic (ROC) curve was obtained to evaluate the total risk score of our proposed criteria as a predictor of the presence of IE, and this was compared to the ROC curve of a previously proposed criteria. The area under the ROC curve for our criteria was 0.710, while the area under the ROC curve for the criteria previously proposed was 0.537 (p < 0.001). The p-value for comparing those 2 areas was less than 0.001, indicating statistical significance. Patients with MRSA bacteremia without any of our proposed clinical criteria have very low risk of developing IE and may not require routine TEE. PMID:26676855

  11. Livestock-associated methicillin-resistant Staphylococcus aureus (MRSA) as causes of human infection and colonization in Germany.

    PubMed

    Köck, Robin; Schaumburg, Frieder; Mellmann, Alexander; Köksal, Mahir; Jurke, Annette; Becker, Karsten; Friedrich, Alexander W

    2013-01-01

    Pigs, cattle and poultry are colonized with MRSA and the zoonotic transmission of such MRSA to humans via direct animal contact, environmental contaminations or meat are a matter of concern. Livestock-associated (LA) MRSA are mostly belonging to clonal complex (CC) 398 as defined by multilocus sequence typing. However, MRSA of other clonal lineages including CC5, CC9 and CC97 have also been detected in livestock animals in Germany. Within the framework of a Dutch-German network project (EUREGIO), 14,036 MRSA isolated from clinical and screening specimens (January 2008 - June 2012) derived from human patients in hospitals as well as general or specialized practices in a German region characterized by a high density of livestock production, were subjected to S. aureus protein A (spa) sequence typing. The prevalence of putative LA-MRSA among the human MRSA isolates was determined by analyzing the detection of livestock-indicator (LI) spa types which had already been reported in German livestock. Overall, 578 spa types were detected among the MRSA isolates. LI spa types t011, t034, t108, t1451, t2011, t571, t1456, t1250, t1255, t1580, t2970, t2346, t1344, t2576, t2330 and t2510 (all of which are indicative for LA-MRSA CC398) accounted for 18.6% of all human isolates. The LI spa types t1430 (CC9), t3992 (CC97), t002 (CC5) and t007 (CC30) were found in 0.14%, 0.01%, 1.01% and 0.04% of all human MRSA isolates, respectively. LI spa types associated with CC398 represented 23% of all MRSA from screening samples and a varying proportion among isolates from clinical specimens ranging between 0% in cerebrospinal fluid, 8% in blood cultures and 14% in deep respiratory fluids. Our findings indicate that LA-MRSA are a major cause for human infection and stress the need for close surveillance. Although LA-MRSA CC398 predominates, the occurrence of putative LA-MRSA from other clonal lineages should be monitored. PMID:23418434

  12. A novel nitro-dexamethasone inhibits agr system activity and improves therapeutic effects in MRSA sepsis models without antibiotics

    PubMed Central

    Yang, Yun; Li, Haibo; Sun, Hongwu; Gong, Li; Guo, Ling; Shi, Yun; Cai, Changzhi; Gu, Hao; Song, Zhen; Yang, Liuyang; Tong, Yanan; Wei, Chao; Zou, Quanming; Zeng, Hao

    2016-01-01

    Methicillin-resistant Staphylococcus aureus (MRSA) sepsis is a life-threatening medical condition that involves systemic inflammation throughout the body. Glucocorticoids are widely used in combination with antibiotics in the treatment of MRSA sepsis to fight the overwhelming inflammation. Here, we describe the improved anti-inflammatory properties of a nitric oxide (NO)-releasing derivative of dexamethasone, ND8008. ND8008 affected MRSA biofilm formation, caused biofilm cell death, and reduced the effects of virulence factors, such as α-toxin, by inhibiting the activity of the Staphylococcus aureus accessory gene regulator (agr) system. Dosing of mice with ND8008 (127.4 nmol/kg, i.p.) alone greatly reduced the inflammatory response caused by MRSA blood stream infection and considerably increased the survival rate of septic mice. These findings suggest that this novel NO-releasing derivative of dexamethasone ND8008 could be helpful in the treatment of MRSA sepsis. PMID:26839286

  13. Is acetaminophen use associated with atopic eczema and other allergic diseases in adolescents?

    PubMed

    Suárez-Varela, María Morales; García-Marcos, Luís; Fernández-Espinar, Javier Fuertes; Bercedo-Sanz, Alberto; Aguinaga-Ontoso, Inés; González-Díaz, Carlos; Carvajal-Urueña, Ignacio; Busquet-Monge, Rosa María; Arnedo-Pena, Alberto; García de Andoin, Nagore; Batlles-Garrido, José; Blanco-Quirós, Alfredo; López-Silvarrey Varela, Angel; García-Hernández, Gloria; Gimeno-Clemente, Natalia; Rubio-López, Nuria; Llopis-González, Agustín

    2013-06-01

    Atopic Eczema (AE) is a chronic inflammatory skin disease that affects children and adults, and alters quality of life. Previous studies have suggested several socio-demographic and environmental factors related to the prevalence of AE and other allergic diseases, including acetaminophen use. In the present study, we report the rates of isolated AE, AE associated with asthma and AE associated with rhinitis among 13- to 14-year-old Spanish adolescents and the level of association of these conditions with the use of acetaminophen. We analyzed Spanish data from a cross-sectional Phase 3 study within ISAAC. A total of 28,717 adolescents completed the Phase 3 written questionnaire by answering questions for acetaminophen use and on asthma, rhinitis and AE symptoms.We observed an association between acetaminophen use and AE among the adolescents who had used acetaminophen in the previous month. Furthermore, the prevalence rate increased with the number of allergic processes: for AE alone, the adjusted Prevalence Ratio (aPR) was 1.81 and for AE associated with rhinitis or with asthma, aPRs were 2.20 and 3.03, respectively.We conclude that acetaminophen use in childhood may be an important factor associated with development and/or maintenance of AE and other allergic diseases. PMID:23754349

  14. Psychoendocrine and psychoneuroimmunological mechanisms in the comorbidity of atopic eczema and attention deficit/hyperactivity disorder.

    PubMed

    Buske-Kirschbaum, A; Schmitt, J; Plessow, F; Romanos, M; Weidinger, S; Roessner, V

    2013-01-01

    Epidemiological data indicate that atopic eczema (AE) in infancy significantly increases the risk for attention deficit/hyperactivity disorder (ADHD) in later life. The underlying pathophysiological mechanisms of this comorbidity are unknown. We propose that the release of inflammatory cytokines caused by the allergic inflammation and/or elevated levels of psychological stress as a result of the chronic disease interfere with the maturation of prefrontal cortex regions and neurotransmitter systems involved ADHD pathology. Alternatively, increased stress levels in ADHD patients may trigger AE via neuroimmunological mechanisms. In a third model, AE and ADHD may be viewed as two separate disorders with one or more shared risk factors (e.g., genetics, prenatal stress) that increase the susceptibility for both disorders leading to the co-occurrence of AE and ADHD. Future investigation of these three models may lead to a better understanding of the mechanisms underlying the observed comorbidity between AE and ADHD and further, to targeted interdisciplinary primary prevention and treatment strategies. PMID:23141851

  15. Psychoendocrine and psychoneuroimmunological mechanisms in the comorbidity of atopic eczema and attention deficit/hyperactivity disorder.

    TOXLINE Toxicology Bibliographic Information

    Buske-Kirschbaum A; Schmitt J; Plessow F; Romanos M; Weidinger S; Roessner V

    2013-01-01

    Epidemiological data indicate that atopic eczema (AE) in infancy significantly increases the risk for attention deficit/hyperactivity disorder (ADHD) in later life. The underlying pathophysiological mechanisms of this comorbidity are unknown. We propose that the release of inflammatory cytokines caused by the allergic inflammation and/or elevated levels of psychological stress as a result of the chronic disease interfere with the maturation of prefrontal cortex regions and neurotransmitter systems involved ADHD pathology. Alternatively, increased stress levels in ADHD patients may trigger AE via neuroimmunological mechanisms. In a third model, AE and ADHD may be viewed as two separate disorders with one or more shared risk factors (e.g., genetics, prenatal stress) that increase the susceptibility for both disorders leading to the co-occurrence of AE and ADHD. Future investigation of these three models may lead to a better understanding of the mechanisms underlying the observed comorbidity between AE and ADHD and further, to targeted interdisciplinary primary prevention and treatment strategies.

  16. Guidelines for diagnosis, prevention and treatment of hand eczema--short version.

    PubMed

    Diepgen, Thomas L; Andersen, Klaus E; Chosidow, Oliver; Coenraads, Peter Jan; Elsner, Peter; English, John; Fartasch, Manigé; Gimenez-Arnau, Ana; Nixon, Rosemary; Sasseville, Denis; Agner, Tove

    2015-01-01

    The guidelines aim to provide advice on the management of hand eczema (HE), using an evidence- and consensus-based approach. The guidelines consider a systematic Cochrane review on interventions for HE, which is based on a systematic search of the published literature (including hand-searching). In addition to the evidence- and consensus-based recommendation on the treatment of HE, the guidelines cover mainly consensus-based diagnostic aspects and preventive measures (primary and secondary prevention). Treatment recommendations include non-pharmacological interventions, topical, physical and systemic treatments. Topical corticosteroids are recommended as first line treatment in the management of HE, however continuous long-term treatment beyond six weeks only when necessary and under careful medical supervision. Alitretinoin is recommended as a second line treatment (relative to topical corticosteroids) for patients with severe chronic HE. Randomized control trials (RCT) are missing for other used systemic treatments and comparison of systemic drugs in "head-to-head" RCTs are needed. The guidelines development group is a working group of the European Society of Contact Dermatitis (ESCD) and has carefully tried to reconcile opposite views, define current optimal practice and provide specific recommendations, and meetings have been chaired by a professional moderator of the AWMF (Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften; Association of the Scientific Medical Societies in Germany). No financial support was given by any medical company. The guidelines are expected to be valid until December 2017 at the latest. PMID:25640512

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

    PubMed Central

    Reyes, Jinnethe; Rincón, Sandra; Díaz, Lorena; Panesso, Diana; Contreras, Germán A.; Zurita, Jeannete; Carrillo, Carlos; Rizzi, Adele; Guzmán, Manuel; Adachi, Javier; Chowdhury, Shahreen; Murray, Barbara E.; Arias, Cesar A.

    2009-01-01

    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. PMID:19911971

  18. ‘You don't know which bits to believe’: qualitative study exploring carers’ experiences of seeking information on the internet about childhood eczema

    PubMed Central

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

    2015-01-01

    Objective We sought to explore parents and carers’ experiences of searching for information about childhood eczema on the internet. Design A qualitative interview study was carried out among carers of children aged 5 years or less with a recorded diagnosis of eczema. The main focus of the study was to explore carers’ beliefs and understandings around eczema and its treatment. As part of this, we explored experiences of formal and informal information seeking about childhood eczema. Transcripts of interviews were analysed thematically. Setting Participants were recruited from six general practices in South West England. Participants Interviews were carried out with 31 parents from 28 families. Results Experiences of searching for eczema information on the internet varied widely. A few interviewees were able to navigate through the internet and find the specific information they were looking for (for instance about treatments their child had been prescribed), but more found searching for eczema information online to be a bewildering experience. Some could find no information of relevance to them, whereas others found the volume of different information sources overwhelming. Some said that they were unsure how to evaluate online information or that they were wary of commercial interests behind some information sources. Interviewees said that they would welcome more signposting towards high quality information from their healthcare providers. Conclusions We found very mixed experiences of seeking eczema information on the internet; but many participants in this study found this to be frustrating and confusing. Healthcare professionals and healthcare systems have a role to play in helping people with long-term health conditions and their carers find reliable online information to support them with self-care. PMID:25854963

  19. Risk factors for methicillin-resistant Staphylococcus aureus skin and soft tissue infection in MRSA-colonized patients discharged from a Veterans Affairs hospital.

    PubMed

    Cadena, J; Richardson, A M; Frei, C R

    2016-02-01

    Currently, limited studies have quantified the risk of methicillin-resistant Staphylococcus aureus (MRSA) skin and soft tissue infections (SSTIs) for MRSA-colonized patients on discharge from hospital. Our retrospective, case-control study identified independent risk factors for the development of MRSA SSTIs among such patients detected by active MRSA nasal screening in an acute care hospital by PCR on admission, and bacteriological cultures on discharge. Cases were MRSA-colonized patients aged ⩾18 years who developed a MRSA SSTI post-discharge and controls were those who did not develop a MRSA SSTI post-discharge. Controls were matched to cases by length of follow-up (±10 days) for up to 18 months. Potential demographic and clinical risk factors for MRSA infection were identified using electronic queries and manual chart abstraction; data were compared by standard statistical tests and variables with P values ⩽0·05 in bivariable analysis were entered into a logistic regression model. Multivariable analysis demonstrated prior hospital admission within 12 months (P = 0·02), prior MRSA infection (P = 0·05), and previous myocardial infarction (P = 0·01) were independently predictive of a MRSA SSTI post-discharge. Identification of MRSA colonization upon admission and recognition of risk factors could help identify a high-risk population that could benefit from MRSA SSTI prevention strategies. PMID:26194247

  20. Looking toward basic science for potential drug discovery targets against community-associated MRSA

    PubMed Central

    Otto, Michael

    2009-01-01

    The difficulties to find a conventional vaccine against S. aureus and the increasing resistance of S. aureus to many antibiotics demand the exploration of novel therapeutic options, such as by targeting virulence determinants and using specific antibodies in an antitoxin-like approach. Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) strains have recently emerged predominantly in the U.S., causing epidemic outbreaks of mostly skin and soft tissue infections, but also more dramatic and sometimes fatal diseases. CA-MRSA is now the most frequent cause of death by a single infectious agent in the U.S. The fact that at least in the U.S., CA-MRSA infections are almost entirely due to one sequence type, USA300, gives researchers a novel, unique chance to focus on one clone in their efforts to analyze pathogenesis in a clinically important S. aureus. While the molecular underpinnings of the exceptional virulence and transmissibility of USA300 are not yet well understood, recent findings indicate that increased expression of widespread virulence determinants and acquisition of mobile genetic elements have to be considered. Delineating the relative importance of virulence determinants in USA300 and other important clinical strains is a key endeavor needed to develop a potential antitoxin for CA-MRSA disease. PMID:19399829

  1. The effects of antibiotics combined with natural polyphenols against clinical methicillin-resistant Staphylococcus aureus (MRSA).

    PubMed

    Lin, Rong-Dih; Chin, Yi-Ping; Hou, Wen-Chi; Lee, Mei-Hsien

    2008-06-01

    Novel therapies are needed to address the public health problem posed by methicillin-resistant STAPHYLOCOCCUS AUREUS (MRSA). In this study, we determined the effects of combinations of antibiotics and plant polyphenols against 20 clinical isolates of MRSA. The IN VITRO activities of 10 antibiotics and 15 natural polyphenols against the isolates were evaluated by determining minimum inhibitory concentrations (MICs). All isolates were susceptible to vancomycin and resistant to rifampicin, while susceptibilities to ciprofloxacin varied. Among the 15 natural polyphenols, kaempferol (3,4',5,7-tetrahydroxyflavone) and quercetin (3,3',4',5,7-pentahydroxyflavone) showed the lowest MICs. In checkerboard assays, combinations of rifampicin and either kaempferol or quercetin acted synergistically or partially synergistically against the clinical MRSA isolates. Rifampicin combined with kaempferol or quercetin exhibited good beta-lactamase inhibitory effects (57.8 % and 75.8 %, respectively) against a representative isolate according to nitrocefin analysis. The study results and ready availability and low toxicity of plant polyphenols warrant further investigations on the therapeutic potential of combination therapies for MRSA infections. PMID:18546080

  2. The efficacy of silver dressings and antibiotics on MRSA and MSSA isolated from burn patients.

    PubMed

    Percival, Steven L; Thomas, John G; Slone, Will; Linton, Sara; Corum, Linda; Okel, Tyler

    2011-11-01

    In this study our objectives were (1) to investigate whether meticillin-resistant Staphylococcus aureus (MRSA) showed an increased tolerance to silver wound dressings compared with meticillin-sensitive S.?aureus (MSSA); and (2) to evaluate the effects of bacterial phenotypic states of MRSA and MSSA, and pH, on the activity of silver wound dressings and two antibiotics, ampicillin and clindamycin. Twenty MRSA strains and 10 MSSA strains isolated from burns patients in South Africa were evaluated for their susceptibility to a silver alginate and a silver carboxymethyl cellulose wound dressing, employing a corrected zone of inhibition assay, conducted on Mueller Hinton agar and a poloxamer-based biofilm model. When exposed to the two silver dressings, all 30 S.?aureus strains showed susceptibility. Possible enhanced antimicrobial efficacy of the silver dressings occurred when pH was lowered to 5.5, compared with a pH of 7.0. When all S.?aureus were grown in the biofilm phenotypic state and exposed to both silver dressings and antibiotics, enhanced tolerance was noted. Susceptibility to silver was overall higher for MRSA when compared with MSSA. This study showed that the effect of pH and bacterial phenotypic state must be considered when the antimicrobial activity of silver wound dressings is being investigated. It is evident from the data generated that both pH and the bacterial phenotypic state are factors that induce changes that affect both antimicrobial performance and bacterial susceptibility. PMID:22092847

  3. Staphylococcus aureus and MRSA Growth and Biofilm Formation after Treatment with Antibiotics and SeNPs

    PubMed Central

    Cihalova, Kristyna; Chudobova, Dagmar; Michalek, Petr; Moulick, Amitava; Guran, Roman; Kopel, Pavel; Adam, Vojtech; Kizek, Rene

    2015-01-01

    Methicillin-resistant Staphylococcus aureus (MRSA) is a dangerous pathogen resistant to β-lactam antibiotics. Due to its resistance, it is difficult to manage the infections caused by this strain. We examined this issue in terms of observation of the growth properties and ability to form biofilms in sensitive S. aureus and MRSA after the application of antibiotics (ATBs)—ampicillin, oxacillin and penicillin—and complexes of selenium nanoparticles (SeNPs) with these ATBs. The results suggest the strong inhibition effect of SeNPs in complexes with conventional ATBs. Using the impedance method, a higher disruption of biofilms was observed after the application of ATB complexes with SeNPs compared to the group exposed to ATBs without SeNPs. The biofilm formation was intensely inhibited (up to 99% ± 7% for S. aureus and up to 94% ± 4% for MRSA) after application of SeNPs in comparison with bacteria without antibacterial compounds whereas ATBs without SeNPs inhibited S. aureus up to 79% ± 5% and MRSA up to 16% ± 2% only. The obtained results provide a basis for the use of SeNPs as a tool for the treatment of bacterial infections, which can be complicated because of increasing resistance of bacteria to conventional ATB drugs. PMID:26501270

  4. "Not Rocket Science" or "No Silver Bullet"? Media and Government Discourses about MRSA and Cleanliness

    ERIC Educational Resources Information Center

    Koteyko, Nelya; Nerlich, Brigitte; Crawford, Paul; Wright, Nick

    2008-01-01

    Methicillin-resistant "Staphylococcus aureus" (MRSA), commonly called a superbug, has recently been a major political issue in the UK, playing a significant role in debates over health policy in the general election held in 2005. While science recognizes the lack of evidence with regards to the effectiveness of existing measures implemented to

  5. "Not Rocket Science" or "No Silver Bullet"? Media and Government Discourses about MRSA and Cleanliness

    ERIC Educational Resources Information Center

    Koteyko, Nelya; Nerlich, Brigitte; Crawford, Paul; Wright, Nick

    2008-01-01

    Methicillin-resistant "Staphylococcus aureus" (MRSA), commonly called a superbug, has recently been a major political issue in the UK, playing a significant role in debates over health policy in the general election held in 2005. While science recognizes the lack of evidence with regards to the effectiveness of existing measures implemented to…

  6. ST22 and ST239 MRSA duopoly in Singaporean hospitals: 2006-2010.

    PubMed

    Teo, J; Tan, T Y; Hon, P Y; Lee, W; Koh, T H; Krishnan, P; Hsu, L Y

    2013-01-01

    Surveillance is integral for the monitoring and control of infectious diseases. We conducted prospective laboratory surveillance of methicillin-resistant Staphylococcus aureus (MRSA) in five Singaporean public-sector hospitals from 2006 to 2010, using WHONET 5.6 for data compilation and analysis. Molecular profiling using multilocus variable-number tandem-repeat analysis, staphylococcal cassette chromosome mec classification and multilocus sequence typing was performed for a random selection of isolates. Our results showed overall stable rates of infection and bacteraemia, although there was significant variance among the individual hospitals, with MRSA rates increasing in two smaller hospitals and showing a trend towards decreasing in the two largest hospitals. The proportion of blood isolates that are EMRSA-15 (ST22-IV) continued to increase over time, slowly replacing the multi-resistant ST239-III. A new MRSA clone - ST45-IV - is now responsible for a small subset of hospital infections locally. More effort is required in Singaporean hospitals in order to reduce the rates of MRSA infection significantly. PMID:22394568

  7. hVISA and MRSA endocarditis: an 8-year experience in a tertiary care centre.

    PubMed

    Maor, Y; Belausov, N; Ben-David, D; Smollan, G; Keller, N; Rahav, G

    2014-10-01

    It is not clear if patients with heterogeneous intermediate resistance to vancomycin (hVISA) infectious endocarditis (IE) differ from methicillin-resistant S. aureus (MRSA) IE patients. All cases of hVISA and MRSA IE diagnosed at the Sheba Medical Centre from 2003 to 2010 were included. Isolates were screened prospectively for hVISA. Medical records were reviewed. The t-test, chi-square test, Fisher exact test and Kaplan Meier analysis were used. Fourteen hVISA IE and 32 MRSA IE were identified. The mean age was 76 years, mean Charlson score was 4.5 and 24% of patients had prosthetic valves. Pacemakers and implantable cardioverter-defibrillators (P/ICDs) were more common in the hVISA group (50% vs. 22%, p 0.05). P/ICDs IE occurred in 29% of hVISA patients vs. 6.3% of MRSA patients (p 0.06). hVISA patients had more positive blood cultures (eight vs. five, p 0.007) and a trend toward longer bacteraemia (15 vs. 7.5 days, p 0.08). Vancomycin minimal inhibitory concentrations (MICs) were similar in the two groups (1.5 ?g/mL vs. 1.1 ?g/mL, p 0.11). The MIC to daptomycin was higher in hVISA (0.75 ?g/mL vs. 0.32 ?g/mL, p 0.049). MRSA patients received vancomycin. hVISA patients were switched to other antibiotics. Cardiac surgery and/or P/ICD extraction was performed more commonly in hVISA patients (50% vs. 16%, p 0.027). Mortality was high in both groups (57-66%). The median time to death was 39 days in the hVISA group and 19 days in the MRSA group (p 0.3). hVISA IE is associated with P/ICDs. Both hVISA and MRSA are associated with high mortality. Low rates of surgical intervention and P/ICD extraction reflect the high co-morbidity of patients. Caution should be employed in the empirical use of daptomycin in hVISA patients. PMID:24329974

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

    PubMed

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

    2001-12-01

    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

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

    PubMed Central

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

    2012-01-01

    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. PMID:22529705

  10. Molecular epidemiology of environmental MRSA at an equine teaching hospital: introduction, circulation and maintenance.

    PubMed

    van Balen, Joany; Mowery, Jade; Piraino-Sandoval, Micha; Nava-Hoet, Rocio C; Kohn, Catherine; Hoet, Armando E

    2014-01-01

    The role that environmental contamination might play as a reservoir and a possible source of Methicillin-resistant Staphylococcus aureus (MRSA) for patients and personnel at equine veterinary hospitals remains undefined, as the environment has only been monitored during outbreaks or for short periods. Therefore, the objectives of this study were to determine the monthly presence, distribution, and characteristics of environmental MRSA at an equine hospital, and to establish patterns of contamination over time using molecular epidemiological analyses. For this purpose, a yearlong active MRSA surveillance was performed targeting the environment and incoming patients. Antimicrobial susceptibility testing, SCCmec typing, PFGE typing, and dendrographic analysis were used to characterize and analyze these isolates. Overall, 8.6% of the surfaces and 5.8% of the horses sampled were positive for MRSA. The most common contaminated surfaces were: computers, feed-water buckets, and surgery tables-mats. Ninety percent of the isolates carried SCCmec type IV, and 62.0% were classified as USA500. Molecular analysis showed that new pulsotypes were constantly introduced into the hospital throughout the year. However, maintenance of strains in the environment was also observed when unique clones were detected for 2 consecutive months on the same surfaces. Additionally, pulsotypes were circulating throughout several areas and different contact surfaces of the hospital. Based on these results, it is evident that MRSA is constantly introduced and frequently found in the equine hospital environment, and that some contact surfaces could act as "hot-spots". These contaminated surfaces should be actively targeted for strict cleaning and disinfection as well as regular monitoring. PMID:24641543

  11. Linezolid Has Unique Immunomodulatory Effects in Post-Influenza Community Acquired MRSA Pneumonia

    PubMed Central

    Bhan, Urvashi; Podsiad, Amy B.; Kovach, Melissa A.; Ballinger, Megan N.; Keshamouni, Venkateshwar; Standiford, Theodore J.

    2015-01-01

    Introduction Post influenza pneumonia is a leading cause of mortality and morbidity, with mortality rates approaching 60% when bacterial infections are secondary to multi-drug resistant (MDR) pathogens. Staphylococcus aureus, in particular community acquired MRSA (cMRSA), has emerged as a leading cause of post influenza pneumonia. Hypothesis Linezolid (LZD) prevents acute lung injury in murine model of post influenza bacterial pneumonia Methods Mice were infected with HINI strain of influenza and then challenged with cMRSA at day 7, treated with antibiotics (LZD or Vanco) or vehicle 6 hours post bacterial challenge and lungs and bronchoalveolar lavage fluid (BAL) harvested at 24 hours for bacterial clearance, inflammatory cell influx, cytokine/chemokine analysis and assessment of lung injury. Results Mice treated with LZD or Vanco had lower bacterial burden in the lung and no systemic dissemination, as compared to the control (no antibiotic) group at 24 hours post bacterial challenge. As compared to animals receiving Vanco, LZD group had significantly lower numbers of neutrophils in the BAL (9×103 vs. 2.3×104, p < 0.01), which was associated with reduced levels of chemotactic chemokines and inflammatory cytokines KC, MIP-2, IFN-γ, TNF-α and IL-1β in the BAL. Interestingly, LZD treatment also protected mice from lung injury, as assessed by albumin concentration in the BAL post treatment with H1N1 and cMRSA when compared to vanco treatment. Moreover, treatment with LZD was associated with significantly lower levels of PVL toxin in lungs. Conclusion Linezolid has unique immunomodulatory effects on host inflammatory response and lung injury in a murine model of post-viral cMRSA pneumonia. PMID:25635685

  12. Identification and characterization of methicillin-resistant Staphylococcus aureus (MRSA) from Austrian companion animals and horses.

    PubMed

    Loncaric, Igor; Knzel, Frank; Licka, Theresia; Simhofer, Hubert; Spergser, Joachim; Rosengarten, Renate

    2014-01-31

    The aim of this study was to investigate the antimicrobial resistance, resistance gene patterns and genetic relatedness of a collection of Austrian methicillin-resistant Staphylococcus aureus (MRSA) isolates from companion animals and horses. A total of 89 non-repetitive MRSA isolates collected during routine veterinary microbiological examinations from April 2004 to the end of 2012, and one isolate from 2013 were used for this study. The presence of mecA and other resistance genes was confirmed by PCR. Isolates were genotyped by spa typing, two multiple-locus variable-number tandem repeat analyses (MLVA) analyses, SCCmec typing and multilocus sequence typing (MLST). PCR targeting Panton-Valentine leukocidin (PVL) and detection of staphylococcal enterotoxins (SE), toxic shock syndrome toxin (TSST) was performed using PCR assays. Antimicrobial susceptibility testing was performed. Five sequence types (STs-ST398, ST254, ST22, ST5 and ST1), SCCmec types II, IVa, V, and non-type-abele, 8 spa-types (t003, t011, t036, t127, t386, t1348, and t4450), and two isolates could not be assigned, 21 MLVA-14Orsay types Multiplex-PCR MLVA (mMLVA) displayed 17 different MLVA types. The present study is the most comprehensive dealing with MRSA from Austrian companion animals and horses. The results confirm that MRSA ST398 is present in a wide range of animal species and is predominant especially in horses. In other companion animals it is unclear whether the infections with the different MRSA isolates investigated in the present study truly represents a rare phenomenon or may be an emerging problem in companion animals. PMID:24332703

  13. Healthcare- and Community-Associated Methicillin-Resistant Staphylococcus aureus (MRSA) and Fatal Pneumonia with Pediatric Deaths in Krasnoyarsk, Siberian Russia: Unique MRSA's Multiple Virulence Factors, Genome, and Stepwise Evolution.

    PubMed

    Khokhlova, Olga E; Hung, Wei-Chun; Wan, Tsai-Wen; Iwao, Yasuhisa; Takano, Tomomi; Higuchi, Wataru; Yachenko, Svetlana V; Teplyakova, Olga V; Kamshilova, Vera V; Kotlovsky, Yuri V; Nishiyama, Akihito; Reva, Ivan V; Sidorenko, Sergey V; Peryanova, Olga V; Reva, Galina V; Teng, Lee-Jene; Salmina, Alla B; Yamamoto, Tatsuo

    2015-01-01

    Methicillin-resistant Staphylococcus aureus (MRSA) is a common multidrug-resistant (MDR) pathogen. We herein discussed MRSA and its infections in Krasnoyarsk, Siberian Russia between 2007 and 2011. The incidence of MRSA in 3,662 subjects was 22.0% and 2.9% for healthcare- and community-associated MRSA (HA- and CA-MRSA), respectively. The 15-day mortality rates for MRSA hospital- and community-acquired pneumonia (HAP and CAP) were 6.5% and 50%, respectively. MRSA CAP cases included pediatric deaths; of the MRSA pneumonia episodes available, ≥27.3% were associated with bacteremia. Most cases of HA-MRSA examined exhibited ST239/spa3(t037)/SCCmecIII.1.1.2 (designated as ST239Kras), while all CA-MRSA cases examined were ST8/spa1(t008)/SCCmecIV.3.1.1(IVc) (designated as ST8Kras). ST239Kras and ST8Kras strongly expressed cytolytic peptide (phenol-soluble modulin α, PSMα; and δ-hemolysin, Hld) genes, similar to CA-MRSA. ST239Kras pneumonia may have been attributed to a unique set of multiple virulence factors (MVFs): toxic shock syndrome toxin-1 (TSST-1), elevated PSMα/Hld expression, α-hemolysin, the staphylococcal enterotoxin SEK/SEQ, the immune evasion factor SCIN/SAK, and collagen adhesin. Regarding ST8Kras, SEA was included in MVFs, some of which were common to ST239Kras. The ST239Kras (strain OC3) genome contained: a completely unique phage, φSa7-like (W), with no att repetition; S. aureus pathogenicity island SaPI2R, the first TSST-1 gene-positive (tst+) SaPI in the ST239 lineage; and a super copy of IS256 (≥22 copies/genome). ST239Kras carried the Brazilian SCCmecIII.1.1.2 and United Kingdom-type tst. ST239Kras and ST8Kras were MDR, with the same levofloxacin resistance mutations; small, but transmissible chloramphenicol resistance plasmids spread widely enough to not be ignored. These results suggest that novel MDR and MVF+ HA- and CA-MRSA (ST239Kras and ST8Kras) emerged in Siberian Russia (Krasnoyarsk) associated with fatal pneumonia, and also with ST239Kras, a new (Siberian Russian) clade of the ST239 lineage, which was created through stepwise evolution during its potential transmission route of Brazil-Europe-Russia/Krasnoyarsk, thereby selective advantages from unique MVFs and the MDR. PMID:26047024

  14. Healthcare- and Community-Associated Methicillin-Resistant Staphylococcus aureus (MRSA) and Fatal Pneumonia with Pediatric Deaths in Krasnoyarsk, Siberian Russia: Unique MRSA's Multiple Virulence Factors, Genome, and Stepwise Evolution

    PubMed Central

    Khokhlova, Olga E.; Hung, Wei-Chun; Wan, Tsai-Wen; Iwao, Yasuhisa; Takano, Tomomi; Higuchi, Wataru; Yachenko, Svetlana V.; Teplyakova, Olga V.; Kamshilova, Vera V.; Kotlovsky, Yuri V.; Nishiyama, Akihito; Reva, Ivan V.; Sidorenko, Sergey V.; Peryanova, Olga V.; Reva, Galina V.; Teng, Lee-Jene; Salmina, Alla B.; Yamamoto, Tatsuo

    2015-01-01

    Methicillin-resistant Staphylococcus aureus (MRSA) is a common multidrug-resistant (MDR) pathogen. We herein discussed MRSA and its infections in Krasnoyarsk, Siberian Russia between 2007 and 2011. The incidence of MRSA in 3,662 subjects was 22.0% and 2.9% for healthcare- and community-associated MRSA (HA- and CA-MRSA), respectively. The 15-day mortality rates for MRSA hospital- and community-acquired pneumonia (HAP and CAP) were 6.5% and 50%, respectively. MRSA CAP cases included pediatric deaths; of the MRSA pneumonia episodes available, ≥27.3% were associated with bacteremia. Most cases of HA-MRSA examined exhibited ST239/spa3(t037)/SCCmecIII.1.1.2 (designated as ST239Kras), while all CA-MRSA cases examined were ST8/spa1(t008)/SCCmecIV.3.1.1(IVc) (designated as ST8Kras). ST239Kras and ST8Kras strongly expressed cytolytic peptide (phenol-soluble modulin α, PSMα; and δ-hemolysin, Hld) genes, similar to CA-MRSA. ST239Kras pneumonia may have been attributed to a unique set of multiple virulence factors (MVFs): toxic shock syndrome toxin-1 (TSST-1), elevated PSMα/Hld expression, α-hemolysin, the staphylococcal enterotoxin SEK/SEQ, the immune evasion factor SCIN/SAK, and collagen adhesin. Regarding ST8Kras, SEA was included in MVFs, some of which were common to ST239Kras. The ST239Kras (strain OC3) genome contained: a completely unique phage, φSa7-like (W), with no att repetition; S. aureus pathogenicity island SaPI2R, the first TSST-1 gene-positive (tst+) SaPI in the ST239 lineage; and a super copy of IS256 (≥22 copies/genome). ST239Kras carried the Brazilian SCCmecIII.1.1.2 and United Kingdom-type tst. ST239Kras and ST8Kras were MDR, with the same levofloxacin resistance mutations; small, but transmissible chloramphenicol resistance plasmids spread widely enough to not be ignored. These results suggest that novel MDR and MVF+ HA- and CA-MRSA (ST239Kras and ST8Kras) emerged in Siberian Russia (Krasnoyarsk) associated with fatal pneumonia, and also with ST239Kras, a new (Siberian Russian) clade of the ST239 lineage, which was created through stepwise evolution during its potential transmission route of Brazil-Europe-Russia/Krasnoyarsk, thereby selective advantages from unique MVFs and the MDR. PMID:26047024

  15. Livestock-Associated MRSA in Household Members of Pig Farmers: Transmission and Dynamics of Carriage, A Prospective Cohort Study

    PubMed Central

    van Cleef, Brigitte A. G. L.; van Benthem, Birgit H. B.; Verkade, Erwin J. M.; van Rijen, Miranda M. L.; Kluytmans-van den Bergh, Marjolein F. Q.; Graveland, Haitske; Bosch, Thijs; Verstappen, Koen M. H. W.; Wagenaar, Jaap A.; Bos, Marian E. H.; Heederik, Dick; Kluytmans, Jan A. J. W.

    2015-01-01

    This prospective cohort study describes carriage of livestock-associated methicillin-resistant Staphylococcus aureus (LA-MRSA) in household members from 49 farrowing pig farms in the Netherlands (2010–2011). Of 171 household members, 4% were persistent MRSA nasal carriers, and the MRSA prevalence on any given sampling moment was 10% (range 7-11%). Working in the stables (of which 98% was MRSA-positive, prevalence ratio (PR) = 2.11 per 10 hours), working with sows (PR=1.97), and living with an MRSA-positive pig farmer (PR=4.63) were significant determinants for MRSA carriage. Significant protective factors were carriage of methicillin-susceptible Staphylococcus aureus (MSSA) (PR=0.50), and wearing a facemask when working in the stables (37% decreased prevalence). All MRSA strains during the study period were known livestock-associated types. The bacteriophage φ3 was not found in household members. Transmission from pigs and the environment appeared to be important determinants; human-to-human transmission could not sufficiently be differentiated. Wearing a facemask when working in the stables and carriage of MSSA are potential interventional targets. PMID:25993665

  16. Managing skin and soft-tissue infection and nosocomial pneumonia caused by MRSA: a 2014 follow-up survey.

    PubMed

    Dryden, Matthew; Andrasevic, Arjana Tambic; Bassetti, Matteo; Bouza, Emilio; Chastre, Jean; Baguneid, Mo; Esposito, Silvano; Giamarellou, Helen; Gyssens, Inge; Nathwani, Dilip; Unal, Serhat; Voss, Andreas; Wilcox, Mark

    2015-04-24

    As a follow-up to our 2009 survey, in order to explore opinion and practice on the epidemiology and management of meticillin-resistant Staphylococcus aureus (MRSA) in Europe, we conducted a second survey to elicit current opinions on this topic, particularly around antibiotic choice, dose, duration and route of administration. We also aimed to further understand how the management of MRSA has evolved in Europe during the past 5 years. Members of an expert panel of infectious diseases specialists convened in London (UK) in January 2014 to identify and discuss key issues in the management of MRSA. Following this meeting, a survey was developed comprising 36 questions covering a wide range of topics on MRSA complicated skin and soft-tissue infection and nosocomial pneumonia management. The survey instrument, a web-based questionnaire, was sent to the International Society of Chemotherapy for distribution to registered European infection societies and their members. This article reports the survey results from the European respondents. At the time of the original survey, the epidemiology of MRSA varied significantly across Europe and there were differing views on best practice. The current findings suggest that the epidemiology of healthcare-associated MRSA in Europe is, if anything, even more polarised, whilst community-acquired MRSA has become much more common. However, there now appears to be a much greater knowledge of current treatment/management options, and antimicrobial stewardship has moved forward considerably in the 5 years since the last survey. PMID:25867210

  17. Reduction in the incidence of MRSA with use of alcohol-based hand rub solutions and gloves.

    PubMed

    Matsumoto, Kazuaki; Shigemi, Akari; Yaji, Keiko; Shimodozono, Yoshihiro; Takeda, Yasuo; Ikawa, Kazuro; Morikawa, Norifumi; Miyanohara, Hiroaki; Kawamura, Hideki; Orita, Michiyo; Tokuda, Koichi; Nishi, Junichiro; Yamada, Katsushi

    2012-04-01

    Methicillin-resistant Staphylococcus aureus (MRSA) is highly contagious. It is spread by direct contact with MRSA-infected people or objects. Healthcare workers' hands are the most common vehicle for the transmission of healthcare-associated pathogens from patient to patient and within the healthcare environment. The present study aimed to investigate the correlation between the incidence of MRSA among Staphylococcus aureus recovered from clinical culture and the use of alcohol-based hand rub solutions or gloves and antimicrobial use density (AUD). All data were examined every 6 months between January 2005 and June 2008. The increasing use of alcohol-based hand rub solutions was correlated with a decreasing incidence of recovery of MRSA from clinical cultures (r(2) = 0.58). A statistically significant (P < 0.05) correlation (r(2) = 0.68) was observed between glove use and the incidence of MRSA. On the other hand, we did not find any correlation between the AUD of each antibiotic group and the incidence of MRSA. Thus, we suggest that it is important to use not only alcohol-based hand rubs, but also gloves, because MRSA is transmitted from patient to patient by the hands of healthcare workers. PMID:21894454

  18. [Results of Investigation of MRSA Susceptibility to Vancomycin in Clinical Units of Large Multifunctional Hospital and Recommendations on Optimization of Antibacterial Therapy of Staphylococcal Infection].

    PubMed

    Verikovsky, V A; Minakov, O E; Denisova, O I; Bondarenko, E V

    2015-01-01

    The frequency of MRSA and MRSE isolates in various units of the Voronezh Regional Hospital was investigated by the results of the local microbiological monitoring for 2014. The maximum position of MRSA was recorded in the ICU (38 to 75% of the strains). The MRSA strains were characterized by higher methicillin resistance, mainly from the cardiosurgical units (60 to 91% of the isolates). The use of the E-test for MRSA susceptibility to vancomycin allowed to estimate the validity of the use of various antibiotics active against MRSA in the treatment of inpatients and to reduce the risk of ineffective therapy. PMID:27141645

  19. Survey on the risk awareness of german pig and cattle farmers in relation to dealing with MRSA and antibiotics

    PubMed Central

    Schulze-Geisthövel, Sophia Veronika; Tappe, Elisa-Valerie; Schmithausen, Ricarda Maria; Lepkojis, Jan; Röttgen, Katharina; Petersen, Brigitte

    2016-01-01

    Introduction The danger surrounding methicillin-resistant Staphylococcus aureus (MRSA) has been well known for decades. Although MRSA was initially only associated with hospitals, livestock-associated MRSA is being increasingly connected to the way food-supplying animals are treated. However, little is yet known about farmers’ risk awareness and their knowledge of MRSA. Hence, the goal of this study was to discover farmers’ perceptions of MRSA. Materials and methods Two successive studies were performed. Study I analysed the connection between the attitudes of cattle and pig farmers towards MRSA complications and characteristics such as age and vocational training. Study II dealt with the connection between contact frequency with livestock and the risk of MRSA colonisation. Results For Study I, 101 questionnaires were completed. Analysis showed that the participants’ education level (p=0.042, α=0.05) and the animal species kept on their farm (p=0.045, α=0.05) significantly influenced their perceptions. Screening results from 157 participants within Study II showed that contact frequency and the participants’ particular profession were significantly decisive for MRSA prevalence (contact frequency: p=0.000, professional branch: p=0.000, OR=11.966, α=0.05). Discussion The results show a high degree of risk consciousness and responsibility among farmers. However, it is assumed that most farmers who took part in the studies were interested parties. Thus, the study results are valid only for the chosen livestock holdings. Ultimately, educational work is still needed. Joint projects between economics and science offer a good platform to spark farmers’ interest in the MRSA problem, as well as to inform and enlighten them about dangers and connections. Interdisciplinary research will contribute to a better understanding of drug resistance and to reducing the long-term use of antibiotics. PMID:26847732

  20. Involvement of occupational physicians in the management of MRSA-colonised healthcare workers in Germany a survey

    PubMed Central

    2013-01-01

    Background Colonisation of healthcare workers (HCWs) with methicillin-resistant Staphylococcus aureus strains (MRSA) is a challenge for any healthcare facility. Persistent carriage of MRSA among HCWs causes special problems, particularly in occupational-medical care. German occupational physicians responsible for healthcare facilities were therefore asked about their experience in managing MRSA-colonised HCWs. Methods In May 2012, 549 occupational physicians were asked in writing about in-house management of MRSA-colonised HCWs. The semi-standardised survey form contained questions about collaboration between the infection control team and the occupational physician, the involvement of the occupational physician in in-house management of MRSA carriers and the number of persistently colonised HCWs in 2011. The answers were intended to apply to the largest facility cared for by the occupational physician. Results 207 occupational physicians took part in the survey (response rate 38%). In 2011, 73 (35%) occupational physicians were responsible for the occupational-medical management of an average of four MRSA-colonised HCWs. Eleven doctors (5.3% of 207) managed a total of 17 persistently colonised HCWs. One of these 17 employees was dismissed. In the case of MRSA carriage among HCWs, most occupational physicians cooperated with the infection control team (77%) and 39% of occupational physicians were responsible for the occupational-medical management of the affected carrier. 65% of facilities had specified policies for the management of MRSA-colonised HCWs. After the first MRSA-positive screening result, 79% of facilities attempt to decolonise the affected employee. In 6% of facilities, the colonised HCWs were excluded from work while receiving decolonisation treatment. In 54% of facilities, infection control policies demand the removal of MRSA carriers from patient care. Conclusions Not all facilities have policies for the management of MRSA-colonised HCWs and there are major differences in occupational consequences for the affected HCWs. In order to protect both the employees and the patients, standards for the in-house management of MRSA colonisation in HCWs should be developed. PMID:23710905

  1. Economic Evaluation of a Multifaceted Implementation Strategy for the Prevention of Hand Eczema Among Healthcare Workers in Comparison with a Control Group: The Hands4U Study.

    PubMed

    van der Meer, Esther W C; van Dongen, Johanna M; Boot, Cécile R L; van der Gulden, Joost W J; Bosmans, Judith E; Anema, Johannes R

    2016-04-12

    The aim of this study was to evaluate the cost-effectiveness of a multifaceted implementation strategy for the prevention of hand eczema in comparison with a control group among healthcare workers. A total of 48 departments (n=1,649) were randomly allocated to the implementation strategy or the control group. Data on hand eczema and costs were collected at baseline and every 3 months. Cost-effectiveness analyses were performed using linear multilevel analyses. The probability of the implementation strategy being cost-effective gradually increased with an increasing willingness-to-pay, to 0.84 at a ceiling ratio of €590,000 per person with hand eczema prevented (societal perspective). The implementation strategy appeared to be not cost-effective in comparison with the control group (societal perspective), nor was it cost-beneficial to the employer. However, this study had some methodological problems which should be taken into account when interpreting the results. PMID:26573488

  2. Can Panton Valentine Leukocidin Gene And Clindamycin Susceptibility Serve As Predictors of Community Origin of MRSA From Skin and Soft Tissue Infections?

    PubMed Central

    Shashindran, Nandita; Nagasundaram, Niveditha; Thappa, Devinder Mohan

    2016-01-01

    Introduction Community associated Methicillin-resistant Staphylococcus aureus (CA-MRSA) strains have begun to replace Hospital Associated MRSA (HA-MRSA) strains in hospital settings all over the world. With the epidemiological distinctions between these strains beginning to become ill-defined, the categorisation of a strain as CA-MRSA or HA-MRSA is dependent on molecular methods to detect the presence of SCCmec (Staphylococcal Cassette Chromosome mec) elements. However other markers like the presence of Panton Valentine Leukocidin toxin (pvl) genes or Clindamycin susceptibility may also be associated with community origin of MRSA. Aim To determine the prevalence of CA-MRSA among MRSA strains isolated from skin and soft tissue infections and to evaluate the usefulness of Panton Valentine Leukocidin and Clindamycin susceptibility as markers of community origin of MRSA. Materials and Methods One hundred isolates of MRSA from skin and soft tissue were studied for the presence of SCCmec IV and V genes and Panton valentine leukocidin gene by Polymerase chain reaction. Inducible clindamycin resistance was screened for using the D-test. Statistical analysis used Fischer’s exact test. A p-value <0.05 was considered significant Results Eighteen out of 100 MRSA strains were found to be CA-MRSA based on presence of SCCmecV. The proportion of Panton Valentine Leukocidin gene carriage among CA- MRSA as compared to HA-MRSA was found to be statistically significant (p<0.0001). Among the CA-MRSA strains, 94.4% were found to be susceptible to Clindamycin as against only 13.4% of the HA-MRSA strains (p<0.0001). The odds of an MRSA strain being CA-MRSA if it was both Clindamycin susceptible and PVL gene positive was calculated to be 68.25 (p<0.0001). Conclusion Both Clindamycin susceptibility and pvl gene carriage were found to be independent predictors of community origin of MRSA, but taken together the association was highly significant. PMID:26894063

  3. Associations between home dampness-related exposures and childhood eczema among 13,335 preschool children in Shanghai, China: A cross-sectional study.

    PubMed

    Cai, Jiao; Liu, Wei; Hu, Yu; Zou, Zhijun; Shen, Li; Huang, Chen

    2016-04-01

    From April 2011 to April 2012, we conducted a cross-sectional study in Shanghai, China. A total of 13,335 modified ISAAC questionnaires (response rate: 85.3%) were returned by parents or guardians for 4-6 year-old children. Six dampness-related indicators (visible mold spots, visible damp stains, damp bed clothing, water damage, window pane condensation, and moldy odor) were used to evaluate home dampness-related exposures. In the present study, we applied logistic regression model to reveal associations, dose-response relationships, and statistical interaction effects of these dampness-related exposures, with childhood eczema, during lifetime since birth (ever) and in the last 12 months before the questionnaire. The dampness-related indicators were frequently reported in the perinatal and current residences. Prevalences of eczema ever and in the last 12 months were 22.9% and 13.2%, respectively. The dampness-related indicators were robustly associated and dose-response related with increased risk of eczema ever and in the last 12 months in the logistic regression analyses, with adjusted for potential confounders. Specifically, in the perinatal residence, visible mold spots or damp stains could increase 46% (OR, 95% CI: 1.46, 1.29-1.66) odds of childhood eczema (ever); in the current residence, visible mold spots and visible damp stains could increase 34% (1.34, 1.14-1.58) and 38% (1.38, 1.22-1.56) odds of childhood eczema (ever), respectively. Associations were not appreciably different between boys and girls, nor were they different between children with and without parental history of atopy. In conclusion, perinatal and current dampness-related exposures in the residence perhaps are risk factors for childhood eczema. PMID:26708528

  4. Lifetime prevalence of childhood eczema and the effect of indoor environmental factors: Analysis in Hispanic and non-Hispanic white children

    PubMed Central

    Kim, Hyo-Bin; Zhou, Hui; Kim, Jeong Hee; Habre, Rima; Bastain, Theresa M.

    2016-01-01

    Background: The prevalence of eczema varies markedly across the globe. It is unclear whether the geographic variation is due to race and/or ethnic differences, environmental exposures, or genetic factors. Objective: We investigated the effects of ethnicity and environmental exposures on eczema in Hispanic white and non-Hispanic white children who participated in the Southern California Children's Health Study. Methods: We performed a cross-sectional study with sociodemographic predictors and environmental exposures among Hispanic white and non-Hispanic white children ages 4–8 years enrolled in the Children's Health Study, 2002–2003. Results: Eczema prevalence differed by ethnicity: Hispanic whites showed lower prevalence (13.8%) compared with non-Hispanic whites (20.2%), and adjustment for sociodemographic factors did not account for the ethnic difference (odds ratio [OR] 0.79 [95% confidence interval {CI}, 0.65–0.95]). Parental history of allergic disease had a larger effect in Hispanic whites than in non-Hispanic whites (p for interaction = 0.005). High maternal education level (OR 1.46 [95% CI, 1.14–1.87]), parental history of allergic disease (OR 2.21 [95% CI, 1.78–2.76]), and maternal smoking during pregnancy (OR 1.44 [95% CI, 1.06–1.95]) increased the risk of eczema. Indoor environmental factors (e.g., mold, water damage, humidifier use) increased the risk of eczema in non-Hispanic whites independent of a parental history of allergic disease, but, in Hispanic whites, increased risks were observed, primarily in children without a parental history of allergic disease. Conclusion: Hispanic white children in southern California had a lower prevalence of eczema than non-Hispanic whites, and this ethnic difference was not accounted for by sociodemographic differences. The effects of a parental history of allergic disease and indoor environmental exposures on eczema varied by ethnicity, which indicated that the etiology of eczema may differ in Hispanic whites and in non-Hispanic whites. PMID:26831849

  5. Inactivating Methicillin Resistant Staphylococcus aureus (MRSA) and Other Pathogens by Bacteriocins OR-7 and E 50-52.

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Worldwide, reports document the increasing frequency of methicillin resistant Staphylococcus aureus (MRSA) infections. Other human pathogens are recognized as unresponsive to antibiotics of last resort. These previously treatable infections now account for increased numbers of human disease and de...

  6. Inactivating Methicillin Resistant Staphylococcus aureus (MRSA) and other Pathogens by Bacteriocins OR-7 and E 50-52.

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Worldwide, reports document the increasing frequency of methicillin resistant Staphylococcus aureus (MRSA) infections. Other human pathogens are recognized as unresponsive to antibiotics of last resort. These previously treatable infections now account for increased numbers of human disease and de...

  7. An FDA-Drug Library Screen for Compounds with Bioactivities against Meticillin-Resistant Staphylococcus aureus (MRSA)

    PubMed Central

    Lau, Qiu Ying; Tan, Yoke Yan Fion; Goh, Vanessa Chai Yin; Lee, David Jing Qin; Ng, Fui Mee; Ong, Esther H. Q.; Hill, Jeffrey; Chia, Cheng San Brian

    2015-01-01

    The lack of new antibacterial drugs entering the market and their misuse have resulted in the emergence of drug-resistant bacteria, posing a major health crisis worldwide. In particular, meticillin-resistant Staphylococcus aureus (MRSA), a pathogen responsible for numerous human infections, has become endemic in hospitals worldwide. Drug repurposing, the finding of new therapeutic indications for approved drugs, is deemed a plausible solution to accelerate drug discovery and development in this area. Towards this end, we screened 1163 drugs approved by the Food and Drug Administration (FDA) for bioactivities against MRSA in a 10 μM single-point assay. After excluding known antibiotics and antiseptics, six compounds were identified and their MICs were determined against a panel of clinical MRSA strains. A toxicity assay using human keratinocytes was also conducted to gauge their potential for repurposing as topical agents for treating MRSA skin infections.

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

    PubMed

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

    1999-10-01

    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

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

    PubMed Central

    2014-01-01

    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. PMID:24996225

  10. Modelling the effect of antimicrobial treatment on carriage of hospital pathogens with application to MRSA.

    PubMed

    Verykouki, E; Kypraios, T; O'neill, P D

    2016-01-01

    Numerous studies have sought to assess the effectiveness of control measures aimed at reducing the spread of pathogens such as Methicillin-resistant Staphylococcus aureus (MRSA) in hospital settings. Far less is known about possible short-term effects of antibiotics and other antimicrobial treatments on pathogen carriage in patients. This paper is concerned with developing and applying methods for the analysis of detailed data on hospital patients which include information on patient treatments and screening tests for the pathogen in question. The carriage status (colonized, or not) of each patient is modelled as a Markov chain, and models for both perfect and imperfect test sensitivity are developed. Goodness-of-fit procedures based on simulation are also proposed. The methods are illustrated using both simulated data and data on MRSA. PMID:26040911

  11. Treatment of MRSA infections in an African-American male with G6PD deficiency.

    PubMed

    Paek, David S; Nadkarni, Milan; Singla, Manav

    2009-10-01

    Glucose-6-phosphate dehydrogenase (G6PD) deficiency affecting erythrocytes is the most common enzymopathy in humans. It requires caution with the intake of oxidizing substances (e.g., medications and foods) because of the threat of hemolysis. Less recognized is the threat of a deficiency in G6PD that alters neutrophil function, which can compromise the killing of microbes by the oxidative burst mechanism. This results from a secondary alteration in the NADPH oxidase pathway. Methicillin-resistant Staphylococcus aureus (MRSA) infection, which is usually observed after exposure in the hospital setting, is becoming increasingly common in a community setting. Here we show the risk of MRSA and G6PD deficiency and discuss the pitfalls of G6PD deficiency. PMID:18450407

  12. Chronic Osteomyelitis of Clavicle in a Neonate: Report of Morbid Complication of Adjoining MRSA Abscess

    PubMed Central

    Suranigi, Shishir Murugharaj; Deniese, Pascal Noel; Rangasamy, Kanagasabai; Najimudeen, Syed; Gnanadoss, James J.

    2016-01-01

    Osteomyelitis of clavicle is rare in neonates. Acute osteomyelitis of clavicle accounts for less than 3% of all osteomyelitis cases. It may occur due to contiguous spread, due to hematogenous spread, or secondary to subclavian catheterization. Chronic osteomyelitis may occur as a complication of residual adjoining abscess due to methicillin resistant staphylococcus aureus (MRSA) sepsis. We report a newborn female with right shoulder abscess that developed chronic clavicular osteomyelitis in follow-up period after drainage. She required multiple drainage procedures and was later successfully managed with bone curettage and debridement. We report this case to highlight that a MRSA abscess may recur due to residual infection from a chronic osteomyelitis sinus. It may be misdiagnosed as hypergranulation tissue of nonhealing wound leading to inappropriate delay in treatment. High index of suspicion, aggressive initial management, and regular follow-up are imperative to prevent this morbid complication. PMID:27051549

  13. Virulence and antimicrobial resistance genes in human MRSA ST398 isolates in Austria.

    PubMed

    Zarfel, G; Krziwanek, K; Johler, S; Hoenigl, M; Leitner, E; Kittinger, C; Masoud, L; Feierl, G; Grisold, A J

    2013-04-01

    This study determined the genetic background of virulence and resistance genes of MRSA ST398 in Austria. From 2004 up to 2008 a total of 41 human isolates of MRSA ST398 were investigated for virulence and resistance gene patterns using DNA microarray chip analysis. Highly similar virulence gene profiles were found in 29 (70·7%) of the isolates but genes encoding Panton-Valentine leukocidin, enterotoxins, or toxic shock syndrome toxin were not detected. Genes conferring resistance to tetracycline and erythromycin-lincosamide were common as all but one of the isolates exhibited tetM and/or tetK, which are involved in tetracycline resistance, and 12 (29·9%) were positive for ermC, conferring resistance to erythromycin/lincosamide. SplitsTree analysis showed that 40 isolates were closely related. Changes in virulence and resistance gene patterns were minimal over the observed time period. PMID:23084630

  14. Virulence and antimicrobial resistance genes in human MRSA ST398 isolates in Austria.

    TOXLINE Toxicology Bibliographic Information

    Zarfel G; Krziwanek K; Johler S; Hoenigl M; Leitner E; Kittinger C; Masoud L; Feierl G; Grisold AJ

    2013-04-01

    This study determined the genetic background of virulence and resistance genes of MRSA ST398 in Austria. From 2004 up to 2008 a total of 41 human isolates of MRSA ST398 were investigated for virulence and resistance gene patterns using DNA microarray chip analysis. Highly similar virulence gene profiles were found in 29 (70·7%) of the isolates but genes encoding Panton-Valentine leukocidin, enterotoxins, or toxic shock syndrome toxin were not detected. Genes conferring resistance to tetracycline and erythromycin-lincosamide were common as all but one of the isolates exhibited tetM and/or tetK, which are involved in tetracycline resistance, and 12 (29·9%) were positive for ermC, conferring resistance to erythromycin/lincosamide. SplitsTree analysis showed that 40 isolates were closely related. Changes in virulence and resistance gene patterns were minimal over the observed time period.

  15. Livestock-Associated Methicillin-Resistant Staphylococcus aureus (LA-MRSA) Isolates of Swine Origin Form Robust Biofilms

    PubMed Central

    Nicholson, Tracy L.; Shore, Sarah M.; Smith, Tara C.; Fraena, Timothy S.

    2013-01-01

    Methicillin-resistant Staphylococcus aureus (MRSA) colonization of livestock animals is common and prevalence rates for pigs have been reported to be as high as 49%. Mechanisms contributing to the persistent carriage and high prevalence rates of livestock-associated methicillin-resistant Staphylococcus aureus (LA-MRSA) strains in swine herds and production facilities have not been investigated. One explanation for the high prevalence of MRSA in swine herds is the ability of these organisms to exist as biofilms. In this report, the ability of swine LA-MRSA strains, including ST398, ST9, and ST5, to form biofilms was quantified and compared to several swine and human isolates. The contribution of known biofilm matrix components, polysaccharides, proteins and extracellular DNA (eDNA), was tested in all strains as well. All MRSA swine isolates formed robust biofilms similar to human clinical isolates. The addition of Dispersin B had no inhibitory effect on swine MRSA isolates when added at the initiation of biofilm growth or after pre-established mature biofilms formed. In contrast, the addition of proteinase K inhibited biofilm formation in all strains when added at the initiation of biofilm growth and was able to disperse pre-established mature biofilms. Of the LA-MRSA strains tested, we found ST398 strains to be the most sensitive to both inhibition of biofilm formation and dispersal of pre-formed biofilms by DNaseI. Collectively, these findings provide a critical first step in designing strategies to control or eliminate MRSA in swine herds. PMID:23951352

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

    PubMed Central

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

    2012-01-01

    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 ε-viniferin, ampelopsin A, balanocarpol, laevifonol and diptoindonesin G and four stilbenoid trimers α-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 α-viniferin on both MRSA strains was 100 μg/mL, whereas those of johorenol A on ATCC 33591 and HUKM strain were 100 μg/mL and 200 μg/mL, respectively. The MIC values of ampelopsin E and vaticanol G were higher than 400 μg/mL. Out of the five stilbenoid dimers, only ε-viniferin was capable of inhibiting the growth of both MRSA strains at MIC 400 μg/mL. The MBC value of ε-viniferin, α-viniferin and johorenol A showed bacteriostatic action against MRSA. The FIC index value of ε-viniferin and α-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

  17. Livestock-associated methicillin-resistant Staphylococcus aureus (LA-MRSA) isolates of swine origin form robust biofilms.

    PubMed

    Nicholson, Tracy L; Shore, Sarah M; Smith, Tara C; Frana, Timothy S; Fraena, Timothy S

    2013-01-01

    Methicillin-resistant Staphylococcus aureus (MRSA) colonization of livestock animals is common and prevalence rates for pigs have been reported to be as high as 49%. Mechanisms contributing to the persistent carriage and high prevalence rates of livestock-associated methicillin-resistant Staphylococcus aureus (LA-MRSA) strains in swine herds and production facilities have not been investigated. One explanation for the high prevalence of MRSA in swine herds is the ability of these organisms to exist as biofilms. In this report, the ability of swine LA-MRSA strains, including ST398, ST9, and ST5, to form biofilms was quantified and compared to several swine and human isolates. The contribution of known biofilm matrix components, polysaccharides, proteins and extracellular DNA (eDNA), was tested in all strains as well. All MRSA swine isolates formed robust biofilms similar to human clinical isolates. The addition of Dispersin B had no inhibitory effect on swine MRSA isolates when added at the initiation of biofilm growth or after pre-established mature biofilms formed. In contrast, the addition of proteinase K inhibited biofilm formation in all strains when added at the initiation of biofilm growth and was able to disperse pre-established mature biofilms. Of the LA-MRSA strains tested, we found ST398 strains to be the most sensitive to both inhibition of biofilm formation and dispersal of pre-formed biofilms by DNaseI. Collectively, these findings provide a critical first step in designing strategies to control or eliminate MRSA in swine herds. PMID:23951352

  18. Transmission and Microevolution of USA300 MRSA in U.S. Households: Evidence from Whole-Genome Sequencing

    PubMed Central

    Alam, Md Tauqeer; Petit, Robert A.; Boyle-Vavra, Susan; Miller, Loren G.; Eells, Samantha J.; Daum, Robert S.

    2015-01-01

    ABSTRACT Methicillin-resistant Staphylococcus aureus (MRSA) USA300 is a successful S. aureus clone in the United States and a common cause of skin and soft tissue infections (SSTIs). We performed whole-genome sequencing (WGS) of 146 USA300 MRSA isolates from SSTIs and colonization cultures obtained from an investigation conducted from 2008 to 2010 in Chicago and Los Angeles households that included an index case with an S. aureus SSTI. Identifying unique single nucleotide polymorphisms (SNPs) and analyzing whole-genome phylogeny, we characterized isolates to understand transmission dynamics, genetic relatedness, and microevolution of USA300 MRSA within the households. We also compared the 146 USA300 MRSA isolates from our study with the previously published genome sequences of the USA300 MRSA isolates from San Diego (n = 35) and New York City (n = 277). We found little genetic variation within the USA300 MRSA household isolates from Los Angeles (mean number of SNPs ± standard deviation, 17.6 ± 35; π nucleotide diversity, 3.1 × 10−5) or from Chicago (mean number of SNPs ± standard deviation, 12 ± 19; π nucleotide diversity, 3.1 × 10−5). The isolates within a household clustered into closely related monophyletic groups, suggesting the introduction into and transmission within each household of a single common USA300 ancestral strain. From a Bayesian evolutionary reconstruction, we inferred that USA300 persisted within households for 2.33 to 8.35 years prior to sampling. We also noted that fluoroquinolone-resistant USA300 clones emerged around 1995 and were more widespread in Los Angeles and New York City than in Chicago. Our findings strongly suggest that unique USA300 MRSA isolates are transmitted within households that contain an individual with an SSTI. Decolonization of household members may be a critical component of prevention programs to control USA300 MRSA spread in the United States. PMID:25759497

  19. First report of mecC MRSA in human samples from Austria: molecular characteristics and clinical data

    PubMed Central

    Kerschner, H.; Harrison, E.M.; Hartl, R.; Holmes, M.A.; Apfalter, P.

    2014-01-01

    Reports of mecC methicillin-resistant Staphylococcus aureus (MRSA) strains have been published from several European countries. We describe the first six mecC MRSA isolates of human origin from Austria and report the application of a rapid PCR test. Candidate isolates (n = 295) received between 2009 and 2013 were investigated phenotypically by cefoxitin screening and streaking on ChromID MRSA plates. The presence of mecC was confirmed in six isolates from blood cultures, wound swabs and screening samples of four female and two male patients (age range 7–89 years) by an in-house PCR method and the new Genspeed MRSA test (Greiner Bio-One, Kremsmünster, Austria). The mecC MRSA were further characterized by whole genome sequencing, multilocus sequence and spa typing. Antimicrobial susceptibility testing was performed by Eucast disk-diffusion method and Vitek 2. The six mecC MRSA isolates were from two clonal lineages (CC130, including a new single-locus variant, and CC599) and four different spa types (t843, t1535, t3256, t5930). Analysis for virulence factor genes yielded lukED, eta, etd2 and edin-B (CC130 isolates) and tst, lukED, eta and sel (ST599 isolates). The Genspeed MRSA test identified mecC in all isolates whereas Vitek 2 failed to detect methicillin resistance in one isolate. The strains were susceptible to a wide range of non-β-lactam antibiotics. All patients were successfully treated or decolonized. mecC MRSA are present in Austria as colonizers but may also cause infections. Thus, laboratories must choose appropriate test methods such as cefoxitin screening and confirmation using molecular assays specifically targeting mecC. PMID:25755883

  20. Implementation of recommendations for hand eczema through a multifaceted strategy. A process evaluation among health care workers.

    PubMed

    van der Meer, Esther W C; Boot, Cécile R L; Jungbauer, Frank H W; Coenraads, Pieter Jan; van der Gulden, Joost W J; Anema, Johannes R

    2014-11-01

    Process data give important insights into how an intervention is implemented. The aim of the present study is to conduct a process evaluation, alongside a randomised controlled trail, on the implementation of recommendations for the prevention of hand eczema. The intervention was carried out in healthcare workers' departments and consisted of working groups and role models. The role models were selected based on their representativeness, their influence on colleagues, and their motivation. The focus of the working group was to implement recommendations for hand eczema at the department by choosing solutions to overcome barriers for implementation. Out of the 104 solutions, 87 were realised. Solutions regarding moisturisers and use of cotton under gloves, were used by 90.9% and 30.8% of the employees, respectively. Of all participants, 58.2% actively engaged with the role models. This process evaluation showed that the intervention was executed according to protocol and that the solutions were implemented well. However, the role model component in the intervention should be improved. PMID:24572935

  1. House dust mite-specific IgA2 is associated with protection against eczema in allergic patients.

    PubMed

    den Hartog, G; van Neerven, R J J; Boot, J D; Jansen, A P H; Savelkoul, H F J

    2016-04-01

    Upon inhalation, house dust mite (HDM) allergens are deposited at the nasal and oral mucosa, where IgA is produced abundantly. IgA subclasses have been linked to protection against respiratory allergy previously. It is currently not known whether and how the human IgA subclasses IgA1 and IgA2 contribute to the clinical status of house dust mite-allergic patients. Saliva and serum samples were collected, and HDM-specific, IgE, IgG4, IgA1 and IgA2 levels were determined. HDM-specific levels of IgA in serum were similar to levels measured in nonallergic controls, but HDM-specific levels of IgA2 in saliva were decreased in allergic subjects. HDM-allergic patients who suffered from rhinitis and eczema showed a significant decrease in IgA2-levels compared to patients who suffered from rhinitis only. Taken together, our findings indicate that HDM-specific IgA2, but not IgA1, levels in serum and saliva are reduced in HDM-allergic patients suffering from eczema. PMID:26582722

  2. Cost Analysis of an Intervention to Prevent Methicillin-Resistant Staphylococcus Aureus (MRSA) Transmission

    PubMed Central

    Chowers, Michal; Carmeli, Yehuda; Shitrit, Pnina; Elhayany, Asher; Geffen, Keren

    2015-01-01

    Introduction Our objective was to assess the cost implications of a vertical MRSA prevention program that led to a reduction in MRSA bacteremia. Methods We performed a matched historical cohort study and cost analysis in a single hospital in Israel for the years 2005-2011. The cost of MRSA bacteremia was calculated as total hospital cost for patients admitted with bacteremia and for patients with hospital-acquired bacteremia, the difference in cost compared to matched controls. The cost of prevention was calculated as the sum of the cost of microbiology tests, single-use equipment used for patients in isolation, and infection control personnel. Results An average of 20,000 patients were screened yearly. The cost of prevention was $208,100 per year, with the major contributor being laboratory cost. We calculated that our intervention averted 34 cases of bacteremia yearly: 17 presenting on admission and 17 acquired in the hospital. The average cost of a case admitted with bacteremia was $14,500, and the net cost attributable to nosocomial bacteremia was $9,400. Antibiotics contributed only 0.4% of the total disease management cost. When the annual cost of averted cases of bacteremia and that of prevention were compared, the intervention resulted in annual cost savings of $199,600. Conclusions A vertical MRSA prevention program targeted at high-risk patients, which was highly effective in preventing bacteremia, is cost saving. These results suggest that allocating resources to targeted prevention efforts might be beneficial even in a single institution in a high incidence country. PMID:26406889

  3. The Impact of Discontinuing Contact Precautions for VRE and MRSA on Device-Associated Infections.

    PubMed

    Edmond, Michael B; Masroor, Nadia; Stevens, Michael P; Ober, Janis; Bearman, Gonzalo

    2015-08-01

    The impact of discontinuing contact precautions for patients with MRSA and VRE colonization/infection on device-associated hospital-acquired infection rates at an academic medical center was investigated in this before-and-after study. In the setting of a strong horizontal infection prevention platform, discontinuation of contact precautions had no impact on device-associated hospital-acquired infection rates. PMID:25915205

  4. Methicillin-resistant staphylococcus aureus (MRSA) carriage in a dermatology unit

    PubMed Central

    Pacheco, Renata L.; Lobo, Renata D.; Oliveira, Maura S.; Farina, Elthon F.; Santos, Cleide R.; Costa, Silvia F.; Padoveze, Maria Clara; Garcia, Cilmara P.; Trindade, Priscila A.; Quitério, Ligia M.; Rivitti, Evandro A.; Mamizuka, Elsa M.; Levin, Anna S.

    2011-01-01

    OBJECTIVE: The aim of this study was to characterize Staphylococcus aureus (MRSA) carriage in a dermatology unit. METHODS: This was a prospective and descriptive study. Over the course of 26 weeks, surveillance cultures were collected weekly from the anterior nares and skin of all patients hospitalized in a 20-bed dermatology unit of a tertiary-care hospital. Samples from healthcare workers (HCWS) were cultured at the beginning and end of the study. Colonized patients were put under contact precautions, and basic infection control measures were enforced. Staphylococcus aureus colonization pressure was determined monthly. Colonized and non-colonized patients were compared, and isolates were evaluated for antimicrobial susceptibility, SCCmec type, virulence factors, and type. RESULTS: Of the 142 patients evaluated, 64 (45%) were colonized by MRSA (39% hospital acquired; 25% community acquired; 36% indeterminate). Despite isolation precautions, hospital-acquired Staphylococcus aureus occurred in addition to the continuous entry of Staphylococcus aureus from the community. Colonization pressure increased from 13% to 59%, and pemphigus and other bullous diseases were associated with MRSA colonization. Eleven out of 71 HCWs (15%) were Staphylococcus aureus carriers, although only one worker carried a persistent clone. Of the hospital-acquired MRSA cases, 14/28 (50%) were SCCmec type IV (3 PFGE types), 13 were SCCmec type III (46%), and one had an indeterminate type. These types were also present among the community-acquired Staphylococcus aureus isolates. SSCmec type IV isolates were shown to be more susceptible than type III isolates. There were two cases of bloodstream infection, and the pvl and tst virulence genes were absent from all isolates. CONCLUSIONS: Dermatology patients were colonized by community- and hospital-acquired Staphylococcus aureus. Half of the nosocomial Staphylococcus aureus isolates were SCCmec type IV. Despite the identification of colonized patients and the subsequent contact precautions and room placement, Staphylococcus aureus colonization continued to occur, and colonization pressure increased. Pemphigus and other bullous diseases were associated with Staphylococcus aureus. PMID:22189732

  5. Antibiofilm Effect of Octenidine Hydrochloride on Staphylococcus aureus, MRSA and VRSA.

    PubMed

    Amalaradjou, Mary Anne Roshni; Venkitanarayanan, Kumar

    2014-01-01

    Millions of indwelling devices are implanted in patients every year, and staphylococci (S. aureus, MRSA and vancomycin-resistant S. aureus (VRSA)) are responsible for a majority of infections associated with these devices, thereby leading to treatment failures. Once established, staphylococcal biofilms become resistant to antimicrobial treatment and host response, thereby serving as the etiological agent for recurrent infections. This study investigated the efficacy of octenidine hydrochloride (OH) for inhibiting biofilm synthesis and inactivating fully-formed staphylococcal biofilm on different matrices in the presence and absence of serum protein. Polystyrene plates and stainless steel coupons inoculated with S. aureus, MRSA or VRSA were treated with OH (zero, 0.5, one, 2 mM) at 37 °C for the prevention of biofilm formation. Additionally, the antibiofilm effect of OH (zero, 2.5, five, 10 mM) on fully-formed staphylococcal biofilms on polystyrene plates, stainless steel coupons and urinary catheters was investigated. OH was effective in rapidly inactivating planktonic and biofilm cells of S. aureus, MRSA and VRSA on polystyrene plates, stainless steel coupons and urinary catheters in the presence and absence of serum proteins. The use of two and 10 mM OH completely inactivated S. aureus planktonic cells and biofilm (>6.0 log reduction) on all matrices tested immediately upon exposure. Further, confocal imaging revealed the presence of dead cells and loss in biofilm architecture in the OH-treated samples when compared to intact live biofilm in the control. Results suggest that OH could be applied as an effective antimicrobial to control biofilms of S. aureus, MRSA and VRSA on appropriate hospital surfaces and indwelling devices. PMID:25437807

  6. The distribution of pathogenic and toxigenic genes among MRSA and MSSA clinical isolates.

    PubMed

    Imani Fooladi, Abbas Ali; Ashrafi, Elnaz; Tazandareh, Shafie Gorbani; Koosha, Roohollah Zarei; Rad, Hamid Sedighian; Amin, Mohsen; Soori, Mina; Larki, Reza Abbasi; Choopani, Ali; Hosseini, Hamideh Mahmoodzadeh

    2015-04-01

    Staphylococcus aureus (S. aureus) is considered as a notorious nosocomial pathogen among hospitalized patients and community-dwelling subjects. Its increasing morbidity and mortality is believed to be due to antibiotic resistance. However, the data concerning molecular properties of infecting strains are few. In this study, a total of 192 S. aureus strains, including 88 (45.8%) meticillin-sensitive S. aureus (MSSA) and 104 (54.2%) meticillin-resistant S. aureus (MRSA) were recovered from clinical samples. The prevalence of subtypes containing staphylococcal cassette chromosome mec (SSCmec), staphylococcal enterotoxins (SEs), toxic shock syndrome toxin (TSST) and exfoliative toxin was assessed by PCR. Antibiotic susceptibility pattern and vancomycin resistance of each isolate were evaluated by disk diffusion method and micro-dilution method, respectively. 9 (2.3%) strains required MIC > 2 mg/l of vancomycin, which significantly increased among multi drug resistant (MDR), MRSA and SCCmec type III strains (p < 0.05). 171 (89%), 140 (72.91%), 7 (3.6), 78 (48.6%), 5 (2.6%), 151 (78.64%), 129 (67.18%), 178 (92.7%) and 15 (7.8%) of 192 isolates harbored mecA, entA, entB, entC, entD, entE, eta, etb and tsst-1 genes, respectively. 31 (16.14%), 5 (2.6%), 95 (49.48%) and 7 (3.64%) of 192 isolates carried SCCmec type I, II, III and IV, respectively. We found a significantly higher rate of MRSA and resistance to all tested antibiotics, except to penicillin G, kanamycin and linezolide among the SCCmec type III class (p < 0.05). According to our findings, MSSA isolates should be taken as seriously as MRSA strains due to the potential presence of broad spectrum virulence factor genes. PMID:25778391

  7. Validation of Treatment Escalation as a Definition of Atopic Eczema Flares

    PubMed Central

    Thomas, Kim S.; Stuart, Beth; O’Leary, Caroline J.; Schmitt, Jochen; Paul, Carle; Williams, Hywel C.; Langan, Sinead

    2015-01-01

    Background Atopic eczema (AE) is a chronic disease with flares and remissions. Long-term control of AE flares has been identified as a core outcome domain for AE trials. However, it is unclear how flares should be defined and measured. Objective To validate two concepts of AE flares based on daily reports of topical medication use: (i) escalation of treatment and (ii) days of topical anti-inflammatory medication use (topical corticosteroids and/or calcineurin inhibitors). Methods Data from two published AE studies (studies A (n=336) and B (n=60)) were analysed separately. Validity and feasibility of flare definitions were assessed using daily global bother (scale 0 to 10) as the reference standard. Intra-class correlations were reported for continuous variables, and odds ratios and area under the receiver operator characteristic (ROC) curve for binary outcome measures. Results Good agreement was found between both AE flare definitions and change in global bother: area under the ROC curve for treatment escalation of 0.70 and 0.73 in studies A and B respectively, and area under the ROC curve of 0.69 for topical anti-inflammatory medication use (Study A only). Significant positive relationships were found between validated severity scales (POEM, SASSAD, TIS) and the duration of AE flares occurring in the previous week – POEM and SASSAD rose by half a point for each unit increase in number of days in flare. Smaller increases were observed on the TIS scale. Completeness of daily diaries was 95% for Study A and 60% for Study B over 16 weeks). Conclusion Both definitions were good proxy indicators of AE flares. We found no evidence that ‘escalation of treatment’ was a better measure of AE flares than ‘use of topical anti-inflammatory medications’. Capturing disease flares in AE trials through daily recording of medication use is feasible and appears to be a good indicator of long-term control. Trial registration Current Controlled Trials ISRCTN71423189 (Study A). PMID:25897763

  8. Building a genomic framework for prospective MRSA surveillance in the United Kingdom and the Republic of Ireland

    PubMed Central

    Reuter, Sandra; Török, M. Estée; Holden, Matthew T.G.; Reynolds, Rosy; Raven, Kathy E.; Blane, Beth; Donker, Tjibbe; Bentley, Stephen D.; Aanensen, David M.; Grundmann, Hajo; Feil, Edward J.; Spratt, Brian G.; Parkhill, Julian; Peacock, Sharon J.

    2016-01-01

    The correct interpretation of microbial sequencing data applied to surveillance and outbreak investigation depends on accessible genomic databases to provide vital genetic context. Our aim was to construct and describe a United Kingdom MRSA database containing over 1000 methicillin-resistant Staphylococcus aureus (MRSA) genomes drawn from England, Northern Ireland, Wales, Scotland, and the Republic of Ireland over a decade. We sequenced 1013 MRSA submitted to the British Society for Antimicrobial Chemotherapy by 46 laboratories between 2001 and 2010. Each isolate was assigned to a regional healthcare referral network in England and was otherwise grouped based on country of origin. Phylogenetic reconstructions were used to contextualize MRSA outbreak investigations and to detect the spread of resistance. The majority of isolates (n = 783, 77%) belonged to CC22, which contains the dominant United Kingdom epidemic clone (EMRSA-15). There was marked geographic structuring of EMRSA-15, consistent with widespread dissemination prior to the sampling decade followed by local diversification. The addition of MRSA genomes from two outbreaks and one pseudo-outbreak demonstrated the certainty with which outbreaks could be confirmed or refuted. We identified local and regional differences in antibiotic resistance profiles, with examples of local expansion, as well as widespread circulation of mobile genetic elements across the bacterial population. We have generated a resource for the future surveillance and outbreak investigation of MRSA in the United Kingdom and Ireland and have shown the value of this during outbreak investigation and tracking of antimicrobial resistance. PMID:26672018

  9. [Methicillin resistance detection in Staphylococcus aureus: comparison between conventional methods and MRSA-Screen latex agglutination technique].

    PubMed

    Soloaga, R; Corso, A; Gagetti, P; Faccone, D; Galas, M

    2004-01-01

    Methicillin-resistant Staphylococcus aureus (MRSA) is a significant pathogen that has emerged over the last four decades, causing both nosocomial and community-acquired infections. Rapid and accurate detection of methicillin resistance in S. aureus is important for the use of appropriate antimicrobial therapy and for the control of nosocomial spread of MRSA strains. We evaluated the efficiency of conventional methods for detection of methicillin resistance such as the disk diffusion, agar dilution, oxacillin agar screen test, and the latex agglutination test MRSA-Screen latex, in 100 isolates of S. aureus, 79 mecA positive and 21 mecA negative. The MRSA-Screen latex (Denka Seiken, Niigata, Japón), is a latex agglutination method that detects the presence of PLP-2a, product of mecA gene in S. aureus. The PCR of the mecA gene was used as the "gold standard" for the evaluation of the different methods tested. The percentages of sensitivity and specificity were as follows: disk difusión 97 and 100%, agar dilution 97 and 95%, oxacillin agar screen test 100 and 100%, and MRSA-Screen latex, 100 and 100 %. All methods presented high sensitivity and specificity, but MRSA-Screen latex had the advantage of giving a reliable result, equivalent to PCR, in only 15 minutes. PMID:15174748

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

    PubMed Central

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

    2012-01-01

    The nonantibiotic small molecule cyslabdan, a labdan-type diterpene produced by Streptomyces sp. K04-0144, markedly potentiated the activity of the β-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 β-lactam resistance in MRSA, and our findings provide a new strategy for combating MRSA. PMID:23166602

  11. Evaluation of rep-PCR/DiversiLab versus PFGE and spa typing in genotyping methicillin-resistant Staphylococcus aureus (MRSA).

    PubMed

    Aguadero, V; Gonzlez Velasco, C; Vindel, A; Gonzalez Velasco, M; Moreno, J J

    2015-01-01

    Pulsed-field gel electrophoresis (PFGE) is the 'gold standard' for genotyping of methicillin-resistant Staphylococcus aureus (MRSA); however, the DiversiLab (DL) system, based on rep-PCR, is faster, simpler and could be better adapted to daily routine hospital work. We genotyped 100 MRSA isolates using PFGE, DL, and spa typing, and evaluated the discriminatory power of each technique and the correlation between them by Simpson's index(SI) and adjusted Rand coefficient (ARI), respectively. The isolates were from clinical samples from eight hospitals in Extremadura (Spain) during 2010. DL separated the 100 MRSA into 18 patterns, with 69% of the isolates grouped into four predominant patterns. spa typing reported 17 spa types, classifying 69% of MRSA into two major types (t067 and t002). PFGE revealed the existence of 27 patterns, gathering 54% of MRSA into three pulse types (E8a, E7a and E7b). SI values were 0.819, 0.726, 0.887 and 0.460 for DL, spa typing, PFGE and CC-BURP, respectively. ARI values of DL over PFGE, spa typing and CC-BURP were 0.151, 0.321 and 0.071, respectively. DL has less discriminatory power than PFGE but more than spa typing. The concordance of DL with PFGE is low, primarily because DL does not discriminate between the three predominant MRSA pulse types in our environment. PMID:26510268

  12. Prevalence, antimicrobial susceptibility and molecular typing of Methicillin-Resistant Staphylococcus aureus (MRSA) in bulk tank milk from southern Italy.

    PubMed

    Parisi, A; Caruso, M; Normanno, G; Latorre, L; Sottili, R; Miccolupo, A; Fraccalvieri, R; Santagada, G

    2016-09-01

    This paper assesses the prevalence of MRSA in bulk tank milk (BTM) samples from southern Italy, and the relationship between the Coagulase Positive Staphylococci count (CPS) and MRSA prevalence. Of 486 BTM samples tested, 12 samples (2.5%) resulted positive for the presence of MRSA. Great genetic diversity was found among the isolates: ST1/t127 and t174/IVa, ST5/t688/V, ST8/t unknown/IVa/V, ST45/t015/IVa, ST71/t524/V, ST88/t786/Iva, ST398/t011 and t899/IVa/V and ST2781/t1730/V. All isolates were pvl-negative and icaA positive. The majority of strains (58%) carried the ses (sec, seh, seg, seo, sem and sen) genes. All tested strains resulted susceptible to amikacin, cephalotin, cloramphenicol, gentamycin, trimethoprim - sulfamethoxazole, tobramycin and vancomycin, and variably resistant to ampicillin, oxacillin and tetracycline. No statistical association between the CPS count and MRSA detection was found in the MRSA-positive samples. Although some of the spa-types and STs detected in our survey are known to cause human infections, raw milk from Italian herds in the considered area is not a common source of MRSA. Nonetheless, it is necessary to assess the risk of foodborne infection and the risk related to the handling of milk. PMID:27217357

  13. Analysis of nosocomial outbreaks with multiply and methicillin-resistant Staphylococcus aureus (MRSA) in Germany: implications for hospital hygiene.

    PubMed

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

    1994-01-01

    Two outbreaks of nosocomial infections with MRSA, one in a urological unit in connection with transurethral prostatectomy and the other in an orthopaedic clinic with infections after implantation of prosthetic hips, have been analyzed on the basis of typing MRSA by phage-patterns, plasmid profiles and genomic DNA fragment patterns. Main reasons for these outbreaks were obviously mistakes in hospital hygiene and an inappropriate antibiotic prophylaxis (in the first outbreak a quinolone over about 7 days, in the second a third generation cephalosporin). Both outbreaks could be stopped by measures of hospital hygiene including isolated or cohort nursing of affected patients, and change in antibiotic prophylaxis. Intensive care units (ICUs) are more often affected by MRSA than other clinical settings. As described by the example of an outbreak with MRSA in a municipal hospital, ICUs can play a special role in intrahospital spread of MRSA. The recently observed inter-regional clonal interhospital dissemination of MRSA in Germany is mainly due to a transfer of patients between hospitals; prewarning of the hospital of destination and a number of hygiene measures can prevent further spread. PMID:7927831

  14. Building a genomic framework for prospective MRSA surveillance in the United Kingdom and the Republic of Ireland.

    PubMed

    Reuter, Sandra; Török, M Estée; Holden, Matthew T G; Reynolds, Rosy; Raven, Kathy E; Blane, Beth; Donker, Tjibbe; Bentley, Stephen D; Aanensen, David M; Grundmann, Hajo; Feil, Edward J; Spratt, Brian G; Parkhill, Julian; Peacock, Sharon J

    2016-02-01

    The correct interpretation of microbial sequencing data applied to surveillance and outbreak investigation depends on accessible genomic databases to provide vital genetic context. Our aim was to construct and describe a United Kingdom MRSA database containing over 1000 methicillin-resistant Staphylococcus aureus (MRSA) genomes drawn from England, Northern Ireland, Wales, Scotland, and the Republic of Ireland over a decade. We sequenced 1013 MRSA submitted to the British Society for Antimicrobial Chemotherapy by 46 laboratories between 2001 and 2010. Each isolate was assigned to a regional healthcare referral network in England and was otherwise grouped based on country of origin. Phylogenetic reconstructions were used to contextualize MRSA outbreak investigations and to detect the spread of resistance. The majority of isolates (n = 783, 77%) belonged to CC22, which contains the dominant United Kingdom epidemic clone (EMRSA-15). There was marked geographic structuring of EMRSA-15, consistent with widespread dissemination prior to the sampling decade followed by local diversification. The addition of MRSA genomes from two outbreaks and one pseudo-outbreak demonstrated the certainty with which outbreaks could be confirmed or refuted. We identified local and regional differences in antibiotic resistance profiles, with examples of local expansion, as well as widespread circulation of mobile genetic elements across the bacterial population. We have generated a resource for the future surveillance and outbreak investigation of MRSA in the United Kingdom and Ireland and have shown the value of this during outbreak investigation and tracking of antimicrobial resistance. PMID:26672018

  15. THE FREQUENCY OF COMMUNITY-ACQUIRED METHICILLIN-RESISTANT STAPHYLOCOCCUS AUREUS (CA-MRSA) AMONG SAMPLES IN INSTITUTE FOR PUBLIC HEALTH IN CANTON SARAJEVO

    PubMed Central

    Bektas, Sabaheta; Obradovic, Amina; Aljicevic, Mufida; Numanovic, Fatima; Hodzic, Dunja; Sporisevic, Lutvo

    2016-01-01

    Background: The increase in the incidence of methicillin-resistant Staphylococcus aureus (MRSA) infections lacking risk factors for exposure to the health care system has been associated with the recognition of new MRSA clones known as community-associated MRSA (CA-MRSA). These strains have been distinguished from health care-associated MRSA (HA-MRSA) strains by epidemiological, molecular and genetic means as well as by antibiotic susceptibility profile, tissue tropism and virulence traits. Objective: To assess prevalence and antibiotic susceptibility profile of CA-MRSA in Canton Sarajevo, Bosnia and Herzegovina. Results: Out of 1.905 positive Staphylococcus aureus isolates from various samples of outpatients collected during six months, 279 (14,64%) were MRSA isolates. Out of 279 MRSA samples, 133 (47,67%) were found in nasal swabs, from which 48 (36,09%) were in the age group <1 year and 39 (29,32 %) are in the age 1-5 year. Rate of the positive skin swabs was highest among the subject of age group <1 year (46 or 54,12 %) and 1-5 year (18 or 21,18 %). Predominantly antibiotic types among MRSA strains are resistant to penicillin and cefoxitin (36,90 %) and to penicillin, cefoxitin and erythromycin (61,35 %). Conclusion: Continued monitoring of epidemiology and emerging drug resistance data is critical for the effective management of these infections. PMID:27047271

  16. Multiple B-cell epitope vaccine induces a Staphylococcus enterotoxin B-specific IgG1 protective response against MRSA infection

    PubMed Central

    Zhao, Zhuo; Sun, He-Qiang; Wei, Shan-Shan; Li, Bin; Feng, Qiang; Zhu, Jiang; Zeng, Hao; Zou, Quan-Ming; Wu, Chao

    2015-01-01

    No vaccine against methicillin-resistant Staphylococcus aureus (MRSA) has been currently approved for use in humans. Staphylococcus enterotoxin B (SEB) is one of the most potent MRSA exotoxins. In the present study, we evaluated the efficacy and immunologic mechanisms of an SEB multiple B-cell epitope vaccine against MRSA infection. Synthetic overlapping peptide ELISA identified three novel B-cell immunodominant SEB epitopes (in addition to those previously known): SEB31–48, SEB133–150, and SEB193–210. Six B-cell immunodominant epitopes (amino acid residues 31–48, 97–114, 133–150, 193–210, 205–222, and 247–261) were sufficient to induce robust IgG1/IgG2b-specific protective responses against MRSA infection. Therefore, we constructed a recombinant MRSA SEB-specific multiple B-cell epitope vaccine Polypeptides by combining the six SEB immunodominant epitopes and demonstrated its ability to induce a robust SEB-specific IgG1 response to MRSA, as well as a Th2-directing isotype response. Moreover, Polypeptides-induced antisera stimulated synergetic opsonophagocytosis killing of MRSA. Most importantly, Polypeptides was more effective at clearing the bacteria in MRSA-infected mice than the whole SEB antigen, and was able to successfully protect mice from infection by various clinical MRSA isolates. Altogether, these results support further evaluation of the SEB multiple B-cell epitope-vaccine to address MRSA infection in humans. PMID:26201558

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

    PubMed Central

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

    2010-01-01

    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. PMID:21120026

  18. Synergistic effect of tetrandrine and ethidium bromide against methicillin-resistant Staphylococcus aureus (MRSA).

    PubMed

    Lee, Young-Seob; Han, Sin-Hee; Lee, Su-Hwan; Kim, Young-Guk; Park, Chung-Berm; Kang, Ok-Hwa; Keum, Joon-Ho; Kim, Sung-Bae; Mun, Su-Hyun; Shin, Dong-Won; Kwon, Dong-Yeul

    2011-10-01

    Methicillin-resistant Staphylococcus aureus (MRSA) along with other resistant bacteria have become a significant social and clinical problem. Therefore, there is an urgent need to develop bioactive compounds from natural products as alternatives to the very few antibiotics that remain effective. Recently, the efflux mechanism has been identified as the main contributor to antibiotic resistance in bacteria. This study therefore aimed to evaluate tetrandrine (TET), an efflux pump inhibitor (EPI), as a potential antibiotic against MRSA. We investigated the antimicrobial activity of TET against 17 MRSA strains, of which 3 selected strains were studied in further detail using a time-kill assay. When these bacterial strains (1 × 10(6) colony-forming units (cfu)/ml) were incubated with TET in a time-kill assay, log-scale bactericidal activity was observed, which lasted for 24 hr. In addition, TET exhibits a synergistic effect when combined with the multi-drug resistance (MDR)-efflux pump substrate ethidium bromide (EtBr). Structure-function studies of the antibiotic activity of TET in combination with EtBr may lead to the discovery of more effective efflux pump inhibitors. PMID:22008539

  19. Rapid bactericidal action of alpha-mangostin against MRSA as an outcome of membrane targeting.

    PubMed

    Koh, Jun-Jie; Qiu, Shengxiang; Zou, Hanxun; Lakshminarayanan, Rajamani; Li, Jianguo; Zhou, Xiaojun; Tang, Charles; Saraswathi, Padmanabhan; Verma, Chandra; Tan, Donald T H; Tan, Ai Ling; Liu, Shouping; Beuerman, Roger W

    2013-02-01

    The emergence of methicillin-resistant Staphylococcus aureus (MRSA) has created the need for better therapeutic options. In this study, five natural xanthones were extracted and purified from the fruit hull of Garcinia mangostana and their antimicrobial properties were investigated. α-Mangostin was identified as the most potent among them against Gram-positive pathogens (MIC=0.78-1.56 μg/mL) which included two MRSA isolates. α-Mangostin also exhibited rapid in vitro bactericidal activity (3-log reduction within 5 min). In a multistep (20 passage) resistance selection study using a MRSA isolated from the eye, no resistance against α-mangostin in the strains tested was observed. Biophysical studies using fluorescence probes for membrane potential and permeability, calcein encapsulated large unilamellar vesicles and scanning electron microscopy showed that α-mangostin rapidly disrupted the integrity of the cytoplasmic membrane leading to loss of intracellular components in a concentration-dependent manner. Molecular dynamic simulations revealed that isoprenyl groups were important to reduce the free energy for the burial of the hydrophobic phenyl ring of α-mangostin into the lipid bilayer of the membrane resulting in membrane breakdown and increased permeability. Thus, we suggest that direct interactions of α-mangostin with the bacterial membrane are responsible for the rapid concentration-dependent membrane disruption and bactericidal action. PMID:22982495

  20. A multi-beach study of Staphylococcus aureus, MRSA, and enterococci in seawater and beach sand.

    PubMed

    Goodwin, Kelly D; McNay, Melody; Cao, Yiping; Ebentier, Darcy; Madison, Melissa; Griffith, John F

    2012-09-01

    Incidences of Staphylococcus aureus and methicillin resistant S. aureus (MRSA) have risen worldwide prompting a need to better understand routes of human exposure and whether standard bacterial water quality monitoring practices adequately account for this potential threat. Beach water and sand samples were analyzed during summer months for S. aureus, enterococci, and MRSA at three southern California beaches (Avalon, Doheny, Malibu Surfrider). S. aureus frequently was detected in samples of seawater (59%, n = 328) and beach sand (53%, n = 358). MRSA sometimes was detected in seawater (1.6%, n = 366) and sand (2.7%, n = 366) at relatively low concentrations. Site specific differences were observed, with Avalon Beach presenting the highest concentrations of S. aureus and Malibu Surfrider the lowest in both seawater and sand. S. aureus concentrations in seawater and sand were correlated to each other and to a variety of other parameters. Multiple linear regression on the combined beach data indicated that significant explanatory variables for S. aureus in seawater were S. aureus in sand, water temperature, enterococci in seawater, and the number of swimmers. In sand, S. aureus concentrations were related to S. aureus in seawater, water temperature, enterococci in seawater, and inversely to surf height classification. Only the correlation to water temperature held for individually analyzed beaches and for S. aureus concentrations in both seawater and sand. To provide context for these results, the prevalence of S. aureus in sand was compared to published fomite studies, and results suggested that beach prevalence was similar to that in homes. PMID:22652414

  1. Mechanisms of NDV-3 vaccine efficacy in MRSA skin versus invasive infection

    PubMed Central

    Yeaman, Michael R.; Filler, Scott G.; Chaili, Siyang; Barr, Kevin; Wang, Huiyuan; Kupferwasser, Deborah; Hennessey, John P.; Fu, Yue; Schmidt, Clint S.; Edwards, John E.; Xiong, Yan Q.; Ibrahim, Ashraf S.

    2014-01-01

    Increasing rates of life-threatening infections and decreasing susceptibility to antibiotics urge development of an effective vaccine targeting Staphylococcus aureus. This study evaluated the efficacy and immunologic mechanisms of a vaccine containing a recombinant glycoprotein antigen (NDV-3) in mouse skin and skin structure infection (SSSI) due to methicillin-resistant S. aureus (MRSA). Compared with adjuvant alone, NDV-3 reduced abscess progression, severity, and MRSA density in skin, as well as hematogenous dissemination to kidney. NDV-3 induced increases in CD3+ T-cell and neutrophil infiltration and IL-17A, IL-22, and host defense peptide expression in local settings of SSSI abscesses. Vaccine induction of IL-22 was necessary for protective mitigation of cutaneous infection. By comparison, protection against hematogenous dissemination required the induction of IL-17A and IL-22 by NDV-3. These findings demonstrate that NDV-3 protective efficacy against MRSA in SSSI involves a robust and complementary response integrating innate and adaptive immune mechanisms. These results support further evaluation of the NDV-3 vaccine to address disease due to S. aureus in humans. PMID:25489065

  2. MRSA: A Density-Equalizing Mapping Analysis of the Global Research Architecture

    PubMed Central

    Addicks, Johann P.; Uibel, Stefanie; Jensen, Anna-Maria; Bundschuh, Matthias; Klingelhoefer, Doris; Groneberg, David A.

    2014-01-01

    Methicillin-resistant Staphylococcus aureus (MRSA) has evolved as an alarming public health thread due to its global spread as hospital and community pathogen. Despite this role, a scientometric analysis has not been performed yet. Therefore, the NewQIS platform was used to conduct a combined density-equalizing mapping and scientometric study. As database, the Web of Science was used, and all entries between 1961 and 2007 were analyzed. In total, 7671 entries were identified. Density equalizing mapping demonstrated a distortion of the world map for the benefit of the USA as leading country with a total output of 2374 publications, followed by the UK (1030) and Japan (862). Citation rate analysis revealed Portugal as leading country with a rate of 35.47 citations per article, followed by New Zealand and Denmark. Country cooperation network analyses showed 743 collaborations with US-UK being most frequent. Network citation analyses indicated the publications that arose from the cooperation of USA and France as well as USA and Japan as the most cited (75.36 and 74.55 citations per collaboration article, respectively). The present study provides the first combined density-equalizing mapping and scientometric analysis of MRSA research. It illustrates the global MRSA research architecture. It can be assumed that this highly relevant topic for public health will achieve even greater dimensions in the future. PMID:25272080

  3. Mupirocin resistance: clinical implications and potential alternatives for the eradication of MRSA.

    PubMed

    Poovelikunnel, T; Gethin, G; Humphreys, H

    2015-10-01

    Mupirocin 2% ointment is used either alone or with skin antiseptics as part of a comprehensive MRSA decolonization strategy. Increased mupirocin use predisposes to mupirocin resistance, which is significantly associated with persistent MRSA carriage. Mupirocin resistance as high as 81% has been reported. There is a strong association between previous mupirocin exposure and both low-level and high-level mupirocin resistance. High-level mupirocin resistance (mupA carriage) is also linked to MDR. Among MRSA isolates, the presence of the qacA and/or qacB gene, encoding resistance to chlorhexidine, ranges from 65% to 91%, which, along with mupirocin resistance, is associated with failed decolonization. This is of significant concern for patient care and infection prevention and control strategies as both these agents are used concurrently for decolonization. Increasing bacterial resistance necessitates the discovery or development of new antimicrobial therapies. These include, for example, polyhexanide, lysostaphin, ethanol, omiganan pentahydrochloride, tea tree oil, probiotics, bacteriophages and honey. However, few of these have been evaluated fully or extensively tested in clinical trials and this is required to in part address the implications of mupirocin resistance. PMID:26142407

  4. First report of identification of livestock-associated MRSA ST9 in retail meat in England.

    PubMed

    Dhup, V; Kearns, A M; Pichon, B; Foster, H A

    2015-10-01

    Sixty percent of all meat consumed in the UK is imported from European countries where there have been increasing reports of methicillin-resistant Staphylococcus aureus (MRSA) identified in food-producing animals, but rarely from such animals in the UK. Thirty samples each of raw chicken, pork and beef, sourced in England, were collected from retail outlets in Greater Manchester. MRSA was recovered from three chicken samples and one each of pork and beef, all from prepackaged supermarket meat. Four isolates were identified as representatives of the most common human healthcare-associated MRSA clone in the UK [EMRSA-15, spa type t032, belonging to multilocus sequence type clonal complex 22 (MLST-CC22)], suggesting contamination from human source(s) during meat processing. The fifth isolate (from chicken) was multiply-resistant (including oxacillin, ciprofloxacin, erythromycin, clindamycin and tetracycline), identified as ST9-SCCmecIV, spa type t1939 and lacked the immune evasion cluster, a characteristic of livestock-associated strains. This lineage has been identified previously from animals and meat products in Asia and mainland Europe but not the UK. PMID:25697759

  5. MRSA Transmission and Infections in a Neonatal Intensive Care Unit Despite Active Surveillance Cultures and Decolonization – Challenges for Infection Prevention

    PubMed Central

    Popoola, Victor O.; Budd, Alicia; Wittig, Sara M.; Ross, Tracy; Aucott, Susan W.; Perl, Trish M.; Carroll, Karen C.; Milstone, Aaron M.

    2013-01-01

    Objective To characterize the epidemiology of MRSA transmission and infections in a level IIIC neonatal intensive care unit (NICU) and identify barriers to MRSA control. Setting and Design Retrospective cohort study in a university-affiliated NICU with an MRSA control program including weekly nares cultures of all neonates and admission nares cultures for neonates transferred from other hospitals or admitted from home. Methods Medical records were reviewed to identify neonates with NICU-acquired MRSA colonization or infection between April 2007 and December 2011. Compliance with hand hygiene and a MRSA decolonization protocol were monitored. Relatedness of MRSA strains were assessed using pulsed-field gel electrophoresis (PFGE). Results Of 3,536 neonates, 74 (2.0%) had a culture grow MRSA, including 62 neonates with NICU-acquired MRSA. Nineteen of 74 neonates (26%) had an MRSA infection, including 8 who became infected before they were identified as MRSA colonized, and 11 of 66 colonized neonates (17%) developed a subsequent infection. Of the 37 neonates that underwent decolonization, 6 (16%) developed a subsequent infection, and 7 of 14 (50%) that remained in the NICU for ≥21 days became recolonized with MRSA. Using PFGE, there were 14 different strain types identified with USA300 being the most common (31%). Conclusions Current strategies to prevent infections including active identification and decolonization of MRSA colonized neonates are inadequate as infants develop infections before being identified as colonized or after attempted decolonization. Future prevention efforts would benefit from improving detection of MRSA colonization, optimizing decolonization regimens, and identifying and interrupting reservoirs of transmission. PMID:24602947

  6. Identification, expression, and characterization of a major salivary allergen (Cul s 1) of the biting midge Culicoides sonorensis relevant for summer eczema in horses

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Salivary proteins of Culicoides biting midges are thought to play a key role in the induction of summer eczema (SE), a seasonal recurrent allergic dermatitis in horses. The present study describes the identification of a candidate allergen in artificially collected saliva of the North American speci...

  7. Impact of Anthelminthic Treatment in Pregnancy and Childhood on Immunisations, Infections and Eczema in Childhood: A Randomised Controlled Trial

    PubMed Central

    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

    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 PMID:23236367

  8. JOINT EFFECT OF PRENATAL EXPOSURE TO FINE PARTICULATE MATTER AND INTAKE OF PARACETAMOL (ACETAMINOPHEN) IN PREGNANCY ON ONSET OF ECZEMA IN EARLY CHILDHOOD. PROSPECTIVE BIRTH COHORT STUDY

    PubMed Central

    Jedrychowski, Wieslaw; Maugeri, Umberto; Spengler, John D.; Miller, Rachel L.; Mrozek-Budzyn, Dorota; Perzanowski, Matt; Kaim, Irena; Flak, Elzbieta; Mroz, Elzbieta; Majewska, Renata; Perera, Frederica

    2011-01-01

    Prenatal Paracetamol (Acetaminophen) has been associated with increased risk of allergic disease in early childhood, an association that could be due to increased altered susceptibility induced by air pollutants. The main goal of the study was to test the hypothesis that prenatal Paracetamol exposure increases the risk of developing eczema in early childhood and that this association is stronger for children who are exposed prenatally to higher concentrations of fine particulate matter (PM2.5). The study sample consisted of 322 women recruited from January 2001 to February 2004 in the Krakow inner city area who gave birth to term babies and completed 5-year follow-up. Paracetamol use in pregnancy was collected by interviews and prenatal personal exposure to over 48 hours was measured in all recruited women in the second trimester of PM2.5 pregnancy. After delivery, every three months in the first 24 months of the newborn’s life and every 6 months later, a detailed standardized face-to-face interview on the infant’s health was administered to each mother by a trained interviewer. During the interviews at each of the study periods after birth, a history of eczema was recorded. By Cox proportional hazard regression, prenatal exposure to Paracetamol increased the risk of eczema by 20% and PM2.5 by 6%, albeit non significantly. However, the the joint exposure to Paracetamol and higher prenatal PM2.5 was significant and doubled the risk of eczema symptoms (HR = 2.07, 95%CI: 1.01 – 4.34). The findings suggest that even very small doses of Paracetamol in pregnancy may affect the occurrence of allergy outcomes such as eczema in early childhood but only at the co-exposure to higher fine particulate matter. PMID:21962593

  9. The Methicillin-resistant Staphylococcus aureus (MRSA) Nasal Real-time PCR: A Predictive Tool for Contamination of the Hospital Environment

    PubMed Central

    Livorsi, DJ; Arif, S; Garry, P; Kundu, MG; Satola, SW; Davis, TH; Batteiger, B; Kressel, AB

    2016-01-01

    Introduction We sought to determine whether the bacterial burden in the nares, as determined by the cycle threshold (CT) value from real-time MRSA PCR, is predictive of environmental contamination with MRSA. Methods Patients identified as MRSA nasal carriers per hospital protocol were enrolled within 72 hours of room admission. Patients were excluded if 1) nasal mupirocin or chlorhexidine body-wash was used within the past month or 2) an active MRSA infection was suspected. Four environmental sites, 6 body sites and a wound, if present, were cultured with pre-moistened swabs. All nasal swabs were submitted for both a quantitative culture and real-time PCR (Roche Lightcycler, Indianapolis, IN). Results 82 patients had a positive MRSA-PCR at study enrollment. There was a negative correlation of moderate strength between the CT value and the number of MRSA colonies in the nares (r= −0.61, p<0.01). Current antibiotic use was associated with lower levels of MRSA nasal colonization (CT value: 30.2 vs. 27.7, p<0.01). Patients who had concomitant environmental contamination had higher median log MRSA nares count (3.9 vs. 2.5, p=0.01) and lower CT values (28.0 vs. 30.2, p<0.01). However, a ROC curve was unable to identify a threshold MRSA nares count that reliably excluded environmental contamination. Conclusions Patients with a higher burden of MRSA in their nares, based on the CT value, were more likely to contaminate their environment with MRSA. However, contamination of the environment cannot be predicted solely by the degree of MRSA nasal colonization. PMID:25627759

  10. First reporting of methicillin-resistant Staphylococcus aureus (MRSA) ST398 in an industrial rabbit holding and in farm-related people.

    PubMed

    Agnoletti, Fabrizio; Mazzolini, Elena; Bacchin, Cosetta; Bano, Luca; Berto, Giacomo; Rigoli, Roberto; Muffato, Giovanna; Coato, Paola; Tonon, Elena; Drigo, Ilenia

    2014-05-14

    Livestock-associated methicillin-resistant Staphylococcus aureus (LA-MRSA) has been described in food-producing animals and farm or slaughterhouse workers involved in the primary industrial production of swine, bovine and poultry. This communication describes the first case of LA-MRSA (ST398, spa types t034 and t5210) occurring in rabbits raised intensively for meat production and involving farm workers or their family members. In 2012-2013, in a study involving 40 rabbit industrial holdings in Italy, one farm was found to have rabbits colonized or infected with MRSA. Four farm workers and one of their relatives were found to be carrying MRSA. In this case holding, rabbits, people and the holding environment were further investigated and followed up by a second sampling five months later. MRSA was found in 48% (11/23) and 25% (15/59) of the rabbits carrying S. aureus at first and second samplings, respectively. Five months after first detection, some farm workers or family members were still MRSA carriers. Surface samples (2/10) and air samples (2/3) were contaminated with MRSA. Air samples yielded MRSA counts of 5 and 15CFU/m(3). MRSA from rabbits and people collected at first sampling were spa types t034 and t5210 belonging to ST398. The MRSA isolates from rabbits and persons tested at second sampling were t034 and t5210, but spa types t1190 and t2970 were also detected in MRSA isolates from rabbits. Tracing the epidemiological pattern earlier may prevent further spread of LA-MRSA in these food producing animals. PMID:24602406

  11. Preventing introduction of livestock associated MRSA in a pig population--benefits, costs, and knowledge gaps from the Swedish perspective.

    PubMed

    Höjgård, Sören; Aspevall, Olov; Bengtsson, Björn; Hæggman, Sara; Lindberg, Maria; Mieziewska, Kristina; Nilsson, Svante; Ericsson Unnerstad, Helle; Viske, Diana; Wahlström, Helene

    2015-01-01

    Antibiotic resistance is a growing concern in human, as well as in veterinary medicine. Part of the problem concerns how to respond to the risk presented by animal reservoirs of resistant bacteria with the potential of spreading to humans. One example is livestock associated methicillin-resistant Staphylococcus aureus (LA-MRSA). In countries where LA-MRSA is endemic in the pig population, people in contact with pigs have a higher risk of being colonised with LA-MRSA, and persons from this group are subjected to precautionary measures when visiting health care facilities. In the present study, it is assumed that, if LA-MRSA was introduced to the Swedish pig population, the prevalence in the risk groups would be the same as in Denmark or the Netherlands (two countries with low human prevalence that have implemented measures to detect, trace and isolate human LA-MRSA cases and, therefore, have comprehensive data with good coverage regarding prevalence of LA-MRSA), and that similar interventions would be taken in Swedish health care facilities. It is also assumed that the Swedish pig population is free of MRSA or that the prevalence is very low. We analyse if it would be efficient for Sweden to prevent its introduction by testing imported live breeding pigs. Given that quarantining and testing at import will prevent introduction to the pig population, the study shows that the preventive measures may indeed generate a societal net benefit. Benefits are estimated to be between € 870 720 and € 1 233 511, and costs to € 211 129. Still, due to gaps in knowledge, the results should be confirmed when more information become available. PMID:25923329

  12. Preventing Introduction of Livestock Associated MRSA in a Pig Population – Benefits, Costs, and Knowledge Gaps from the Swedish Perspective

    PubMed Central

    Hæggman, Sara; Mieziewska, Kristina; Nilsson, Svante; Viske, Diana

    2015-01-01

    Antibiotic resistance is a growing concern in human, as well as in veterinary medicine. Part of the problem concerns how to respond to the risk presented by animal reservoirs of resistant bacteria with the potential of spreading to humans. One example is livestock associated methicillin-resistant Staphylococcus aureus (LA-MRSA). In countries where LA-MRSA is endemic in the pig population, people in contact with pigs have a higher risk of being colonised with LA-MRSA, and persons from this group are subjected to precautionary measures when visiting health care facilities. In the present study, it is assumed that, if LA-MRSA was introduced to the Swedish pig population, the prevalence in the risk groups would be the same as in Denmark or the Netherlands (two countries with low human prevalence that have implemented measures to detect, trace and isolate human LA-MRSA cases and, therefore, have comprehensive data with good coverage regarding prevalence of LA-MRSA), and that similar interventions would be taken in Swedish health care facilities. It is also assumed that the Swedish pig population is free of MRSA or that the prevalence is very low. We analyse if it would be efficient for Sweden to prevent its introduction by testing imported live breeding pigs. Given that quarantining and testing at import will prevent introduction to the pig population, the study shows that the preventive measures may indeed generate a societal net benefit. Benefits are estimated to be between € 870 720 and € 1 233 511, and costs to € 211 129. Still, due to gaps in knowledge, the results should be confirmed when more information become available. PMID:25923329

  13. Comparison between phage-open-reading frame typing and automated repetitive-sequence-based PCR for typing MRSA isolates.

    PubMed

    Osawa, Kayo; Shigemura, Katsumi; Jikimoto, Takumi; Shirakawa, Toshiro; Fujisawa, Masato; Arakawa, Soichi

    2014-08-01

    The methods for typing and epidemiological study for especially antibiotic-resistant bacteria has been issued but there are the debates regarding which method is best for this purpose. The purpose of this study is to investigate and apply a comparatively new technology, phage-open-reading frame typing (POT) and repetitive-sequence-based PCR (rep-PCR) using DiversiLab system and compare for the discrimination of major methicillin-resistant Staphylococcus aureus (MRSA) lineages in epidemiological surveillance. We analyzed 47 representative MRSA stains isolated in Kobe University Hospital between January and December 2009. We performed MRSA typing using the POT kit and rep-PCR using the DiversiLab system. POT method classified all the MRSA strains into 35 clusters, whereas rep-PCR method typed all the MRSA strains in 10 kinds of clusters with a definition of 95% similarity. The discriminatory power and congruence between the methods were compared using the Simpson's index of diversity, adjusted Rand's and Wallace's coefficients. Our statistical analyses showed that the POT (POT 1-2-3 and POT 2-3) revealed a higher discriminatory power in the Simpson's index of diversity (SID; 0.969, range 0.939-1.000 and 0.967, range 0.935-0.998, respectively) for MRSA isolates than the rep-PCR (0.821 (0.767-0.876)). The adjusted Rand's and Wallace's coefficients did not show higher concordance among the methods. In conclusion, we demonstrated that the POT can perform accurate and reliable epidemiological surveillance studies for analyzing the genetic relatedness of MRSA strains. PMID:24736855

  14. The use of vancomycin in the treatment of adult patients with methicillin-resistant Staphylococcus aureus (MRSA) infection: a survey in a tertiary hospital in China

    PubMed Central

    Tang, Jing; Hu, Jiali; Kang, Lei; Deng, Zhengjun; Wu, Jiaofen; Pan, Jiaqian

    2015-01-01

    Background: Vancomycin is frequently used in the treatment of methicillin-resistant Staphylococcus aureus (MRSA). Objectives: To determine MRSA infection status and the use of vancomycin in its treatment at a teaching hospital in China. Methods: We retrospectively reviewed 140 cases of MRSA infection that were treated from January 2013 to October 2014. We analyzed the etiology of MRSA infection and the use of vancomycin in these cases. Results: MRSA infection mainly occurred in elderly patients concomitant with a variety of diseases, which incidence was more in men than women. More cases of MRSA infection were encountered in the ICU than in other departments. The positive culture results for MRSA were obtained in the sputum (38.57%), pharyngeal swab (19.29%), blood (5.71%), and wound secretion (11.43%) samples. The MRSA patients were sensitive to vancomycin, with the minimum inhibitory concentration (MIC) being 1 μg/mL in 53.80% of the cases and 2 μg/mL in 44.10% of the cases, respectively. Among the 35 (25%) cases treated with vancomycin, 23 were cured, while 3 died and 7 (20%) were considered as an unreasonable application. Conclusions: MRSA infection mainly appeared in patients admitted to the ICU. The MIC of vancomycin had a tendency to increase gradually. PMID:26770588

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

    PubMed

    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

    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

  16. Risk factors for MRSA infection in companion animals: results from a case-control study within Germany.

    PubMed

    Vincze, Szilvia; Brandenburg, Anja G; Espelage, Werner; Stamm, Ivonne; Wieler, Lothar H; Kopp, Peter A; Lübke-Becker, Antina; Walther, Birgit

    2014-10-01

    Increasing numbers of companion animals suffering from infections with methicillin-resistant Staphylococcus aureus (MRSA) have been reported in the recent past. These infections are of particular concern because of the limited treatment options for MRSA and their transferability to humans. Since MRSA lineages isolated from infected companion animals often mirror typical human epidemic strains circulating in the same region, successful strategies to combat MRSA need strong and coordinated efforts from both, the human and the veterinary field according to the "One Health" concept. Hence, to identify potential risk factors related to MRSA infections in dogs, cats and horses, a case-control study was conducted, including data on 106 MRSA-infected animal patients as cases and 102 MSSA-infected animals as controls, originating from 155 different veterinary settings within Germany. Demographic data on animal patients, patient history and administration of antibiotics as well as practice/clinic specific parameters were assessed as putative risk factors. Multivariable logistic regression identified the following variables as risk factors for MRSA infection compared to MSSA infection: number of employees working at the veterinary setting (n>10; p<0.001), antibiotic treatment prior to sampling (systemic: p=0.002; local: p=0.049, both: p=0.011) and surgical site infection (p<0.001). Spa typing revealed predominantly clonal complexes well-known for hospital-associated lineages spreading in human health-care settings in Germany (CC5 and CC22) for isolates of dog and cat origin. CC398-MRSA dominated among equine isolates, a CC that was described as a nosocomial pathogen in equine clinical settings before. The identified risk factors and genotyping results are in accordance with numerous study outcomes from the field of human medicine and point towards reasonable problems with nosocomial spread of MRSA, especially within companion animal veterinary clinics. To define targeted infection control strategies against nosocomial pathogens, it is important to accomplish intervention studies addressing routes of transmission in companion animal veterinary settings. PMID:25130703

  17. The Clinical Efficacy of Mometasone Furoate in Multi-Lamellar Emulsion for Eczema: A Double-blinded Crossover Study

    PubMed Central

    Kim, Duk Han; Lee, Hyun Jong; Park, Chun Wook; Kim, Kyu Han; Lee, Kwang Hoon; Ro, Byung In

    2013-01-01

    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. PMID:23467551

  18. Methicillin-resistant Staphylococcus aureus (MRSA) in rehabilitation and chronic-care-facilities: what is the best strategy?

    PubMed Central

    Minary-Dohen, Patrica; Bailly, Pascale; Bertrand, Xavier; Talon, Daniel

    2003-01-01

    Background The risk associated with methicillin-resistant Staphylococcus aureus (MRSA) has been decreasing for several years in intensive care departments, but is now increasing in rehabilitation and chronic-care-facilities (R-CCF). The aim of this study was to use published data and our own experience to discuss the roles of screening for MRSA carriers, the type of isolation to be implemented and the efficiency of chemical decolonization. Discussion Screening identifies over 90% of patients colonised with MRSA upon admission to R-CCF versus only 50% for intensive care units. Only totally dependent patients acquire MRSA. Thus, strict geographical isolation, as opposed to "social reinsertion", is clearly of no value. However, this should not lead to the abandoning of isolation, which remains essential during the administration of care. The use of chemicals to decolonize the nose and healthy skin appeared to be of some value and the application of this procedure could make technical isolation unnecessary in a non-negligible proportion of cases. Summary Given the increase in morbidity associated with MRSA observed in numerous hospitals, the emergence of a community-acquired disease associated with these strains and the evolution of glycopeptide-resistant strains, the voluntary application of a strategy combining screening, technical isolation and chemical decolonization in R-CCF appears to be an urgent matter of priority. PMID:14672540

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

    PubMed Central

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

    2012-01-01

    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. PMID:23271985

  20. Systemic CA-MRSA infection following trauma during soccer match in inner Brazil: clinical and molecular characterization.

    PubMed

    Camargo, Carlos Henrique; da Cunha, Maria de Lourdes Ribeiro de Souza; Bonesso, Mariana Fávero; da Cunha, Fabiana Picoli; Barbosa, Alexandre Naime; Fortaleza, Carlos Magno Castelo Branco

    2013-07-01

    Even though community-acquired methicillin resistant Staphylococcus aureus (CA-MRSA) was described a decade ago, reports from Brazil are scarce and cases occurred in large urban centers. We report MRSA sepsis in a 16-year-old male from a small town and who had no history of exposure to healthcare or recent travel. After trauma during a soccer match, he presented swelling in the right thigh, which evolved in a month to cellulitis complicated by local abscess, orchitis and pneumonia. The patient presented severe sepsis, with fever and respiratory failure. Laboratory findings included blood leukocyte counts above 40,000/mm(3) and thrombocytopenia. He was submitted to mechanical ventilation and therapy with vancomycin and imipenem. He had a slow but favorable response to therapy and was discharged after six weeks of hospitalization. MRSA grew from blood cultures and respiratory aspirates obtained before antimicrobial therapy. The isolate belonged to sequence type 5, spa type t311, harbored SCCmec type IV and genes for Panton-Valentine leukocidin and Enterotoxin A. The pulsed-field gel electrophoresis pattern was distinct from North American classic CA-MRSA clones. However, the sequence type and the spa type revealed that the clone belong to the same clonal complex isolated in Argentina. This is the first CA-MRSA infection reported in that region, with significant epidemiologic and clinical implications. PMID:23602786

  1. Minimum structural requirements for cell membrane leakage-mediated anti-MRSA activity of macrocyclic bis(bibenzyl)s.

    PubMed

    Fujii, Kana; Morita, Daichi; Onoda, Kenji; Kuroda, Teruo; Miyachi, Hiroyuki

    2016-05-01

    Macrocyclic bis(bibenzyl)-type phenolic natural products, found exclusively in bryophytes, exhibit potent antibacterial activity towards methicillin-resistant Staphylococcus aureus (anti-MRSA activity). Here, in order to identify the minimum essential structure for cell membrane leakage-mediated anti-MRSA activity of these compounds, we synthesized acyclic fragment structures and evaluated their anti-MRSA activity. The activities of all of the acyclic fragments tested exhibited similar characteristics to those of the macrocycles, i.e., anti-MRSA bactericidal activity, an enhancing effect on influx and efflux of ethidium bromide (EtBr: fluorescent DNA-binder) in Staphylococcus aureus cells, and bactericidal activity towards a Staphylococcus aureus strain resistant to 2-phenoxyphenol (4). The latter result suggests that they have a different mechanism of action from 4, which is a FabI inhibitor previously proposed to be the minimum active fragment of riccardin-type macrocycles. Thus, cyclic structure is not a necessary condition for cell membrane leakage-mediated anti-MRSA activity of macrocyclic bis(bibenzyl)s. PMID:26995530

  2. Anti-MRSA activity of isoplagiochin-type macrocyclic bis(bibenzyl)s is mediated through cell membrane damage.

    PubMed

    Onoda, Kenji; Sawada, Hiromi; Morita, Daichi; Fujii, Kana; Tokiwa, Hiroaki; Kuroda, Teruo; Miyachi, Hiroyuki

    2015-07-01

    We synthesized three geometrical isomers of a macrocyclic bis(bibenzyl) based on isoplagiochin, a natural product isolated from bryophytes, and evaluated their antibacterial activity towards methicillin-resistant Staphylococcus aureus (anti-MRSA activity). The isomer containing a 1,4-linked ring (5) showed only weak activity, whereas the isomers containing a 1,3-linked (6) or 1,2-linked (7) C ring showed potent anti-MRSA activity. Molecular dynamics calculations indicated that these differences are probably due to differences in the conformational flexibility of the macrocyclic ring; the active compounds 6 and 7 were more rigid than 5. In order to understand the action mechanism of anti-MRSA activity, we investigated the cellular flux of a fluorescent DNA-binder, ethidium bromide (EtBr), in the presence and absence of these macrocycles. The active compound 6 increased the levels of EtBr inflow and outflow in S. aureus cells, as did our potent anti-MRSA riccardin derivative (4), indicating that these compounds increased the permeability of the cytoplasmic membrane. Inactive 5 had no effect on EtBr inflow or outflow. Furthermore, compound 6 abrogated the normal intracellular concentration gradients of Na(+) and K(+) in S. aureus cells, increasing the intracellular Na(+) concentration and decreasing the K(+) concentration, while 5 had no such effect. These results indicate that anti-MRSA-active macrocyclic bis(bibenzyl) derivatives directly damage the gram-positive bacterial membrane, resulting in increased permeability. PMID:25999206

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

    PubMed

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

    2013-12-01

    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-α, 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

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

    PubMed Central

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

    2014-01-01

    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. PMID:25000521

  5. Whole-Genome Sequencing for the Investigation of a Hospital Outbreak of MRSA in China

    PubMed Central

    Kong, Zhenzhen; Zhao, Peipei; Liu, Haibing; Yu, Xiang; Qin, Yanyan; Su, Zhaoliang; Wang, Shengjun; Xu, Huaxi; Chen, Jianguo

    2016-01-01

    Staphylococcus aureus is a globally disseminated drug-resistant bacterial species. It remains a leading cause of hospital-acquired infection, primarily among immunocompromised patients. In 2012, the Affiliated People’s Hospital of Jiangsu University experienced a putative outbreak of methicillin-resistant S. aureus (MRSA) that affected 12 patients in the Neurosurgery Department. In this study, whole-genome sequencing (WGS) was used to gain insight into the epidemiology of the outbreak caused by MRSA, and traditional bacterial genotyping approaches were also applied to provide supportive evidence for WGS. We sequenced the DNA from 6 isolates associated with the outbreak. Phylogenetic analysis was constructed by comparing single-nucleotide polymorphisms (SNPs) in the core genome of 6 isolates in the present study and another 3 referenced isolates from GenBank. Of the 6 MRSA sequences in the current study, 5 belonged to the same group, clustering with T0131, while the other one clustered closely with TW20. All of the isolates were identified as ST239-SCCmecIII clones. Whole-genome analysis revealed that four of the outbreak isolates were more tightly clustered into a group and SA13002 together with SA13009 were distinct from the outbreak strains, which were considered non-outbreak strains. Based on the sequencing results, the antibiotic-resistance gene status (present or absent) was almost perfectly concordant with the results of phenotypic susceptibility testing. Various toxin genes were also analyzed successfully. Our analysis demonstrates that using traditional molecular methods and WGS can facilitate the identification of outbreaks and help to control nosocomial transmission. PMID:26950298

  6. Impact of mupirocin resistance on the transmission and control of healthcare-associated MRSA

    PubMed Central

    Deeny, Sarah R.; Worby, Colin J.; Tosas Auguet, Olga; Cooper, Ben S.; Edgeworth, Jonathan; Cookson, Barry; Robotham, Julie V.

    2015-01-01

    Objectives The objectives of this study were to estimate the relative transmissibility of mupirocin-resistant (MupR) and mupirocin-susceptible (MupS) MRSA strains and evaluate the long-term impact of MupR on MRSA control policies. Methods Parameters describing MupR and MupS strains were estimated using Markov chain Monte Carlo methods applied to data from two London teaching hospitals. These estimates parameterized a model used to evaluate the long-term impact of MupR on three mupirocin usage policies: ‘clinical cases’, ‘screen and treat’ and ‘universal’. Strategies were assessed in terms of colonized and infected patient days and scenario and sensitivity analyses were performed. Results The transmission probability of a MupS strain was 2.16 (95% CI 1.38–2.94) times that of a MupR strain in the absence of mupirocin usage. The total prevalence of MupR in colonized and infected MRSA patients after 5 years of simulation was 9.1% (95% CI 8.7%–9.6%) with the ‘screen and treat’ mupirocin policy, increasing to 21.3% (95% CI 20.9%–21.7%) with ‘universal’ mupirocin use. The prevalence of MupR increased in 50%–75% of simulations with ‘universal’ usage and >10% of simulations with ‘screen and treat’ usage in scenarios where MupS had a higher transmission probability than MupR. Conclusions Our results provide evidence from a clinical setting of a fitness cost associated with MupR in MRSA strains. This provides a plausible explanation for the low levels of mupirocin resistance seen following ‘screen and treat’ mupirocin usage. From our simulations, even under conservative estimates of relative transmissibility, we see long-term increases in the prevalence of MupR given ‘universal’ use. PMID:26338047

  7. Facet joint septic arthritis due to community acquired methicillin resistant Staphylococcus aureus (MRSA) - A case report.

    PubMed

    Purushothaman, Rajesh; Inassi, Jojo; Marthya, Anwar

    2015-10-01

    Septic arthritis of facet joint (SAFJ) is extremely rare. Only about sixty cases have been reported so far. A single case of SAFJ in a series of 491 cases of spinal infections was first reported by David-Chaussé in 1981. A case report of SAFJ was published by Halpin in 1987. With the growing availability and use of MRI, more and more cases are being reported. The most common organism that causes SAFJ is Staphylococcus aureus. We are reporting a case of SAFJ caused by community acquired, methicillin resistant S aureus (MRSA) successfully treated by Linezolid. PMID:26719620

  8. Randomized, Double-Blind, Placebo-Controlled Study on Decolonization Procedures for Methicillin-Resistant Staphylococcus aureus (MRSA) among HIV-Infected Adults

    PubMed Central

    Weintrob, Amy; Bebu, Ionut; Agan, Brian; Diem, Alona; Johnson, Erica; Lalani, Tahaniyat; Wang, Xun; Bavaro, Mary; Ellis, Michael; Mende, Katrin; Crum-Cianflone, Nancy

    2015-01-01

    Background HIV-infected persons have increased risk of MRSA colonization and skin and soft-tissue infections (SSTI). However, no large clinical trial has examined the utility of decolonization procedures in reducing MRSA colonization or infection among community-dwelling HIV-infected persons. Methods 550 HIV-infected adults at four geographically diverse US military HIV clinics were prospectively screened for MRSA colonization at five body locations every 6 months during a 2-year period. Those colonized were randomized in a double-blind fashion to nasal mupirocin (Bactroban) twice daily and hexachlorophene (pHisoHex) soaps daily for 7 days compared to placeboes similar in appearance but without specific antibacterial activity. The primary endpoint was MRSA colonization at 6-months post-randomization; secondary endpoints were time to MRSA clearance, subsequent MRSA infections/SSTI, and predictors for MRSA clearance at the 6-month time point. Results Forty-nine (9%) HIV-infected persons were MRSA colonized and randomized. Among those with 6-month colonization data (80% of those randomized), 67% were negative for MRSA colonization in both groups (p = 1.0). Analyses accounting for missing 6-month data showed no significant differences could have been achieved. In the multivariate adjusted models, randomization group was not associated with 6-month MRSA clearance. The median time to MRSA clearance was similar in the treatment vs. placebo groups (1.4 vs. 1.8 months, p = 0.35). There was no difference on subsequent development of MRSA infections/SSTI (p = 0.89). In a multivariable model, treatment group, demographics, and HIV-specific factors were not predictive of MRSA clearance at the 6-month time point. Conclusion A one-week decolonization procedure had no effect on MRSA colonization at the 6-month time point or subsequent infection rates among community-dwelling HIV-infected persons. More aggressive or novel interventions may be needed to reduce the burden of MRSA in this population. Trial Registration ClinicalTrials.gov NCT00631566 PMID:26018036

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

    PubMed

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

    2003-01-01

    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

  10. Risk factors for persistence of livestock-associated MRSA and environmental exposure in veal calf farmers and their family members: an observational longitudinal study

    PubMed Central

    Dorado-Garca, Alejandro; Bos, Marian EH; Graveland, Haitske; Van Cleef, Brigitte AGL; Verstappen, Koen M; Kluytmans, Jan AJW; Wagenaar, Jaap A; Heederik, Dick JJ

    2013-01-01

    Objectives Livestock-associated methicillin-resistant Staphylococcus aureus (LA-MRSA) emergence is a major public health concern. This study was aimed at assessing risk factors for persistently carrying MRSA in veal calf farmers and their family members. We also evaluate the dynamics of MRSA environmental load during the veal-calf production cycle. Design Observational, longitudinal, repeated cross-sectional study. Setting 52 veal calf farms in the Netherlands. Participants From the end of 2010 to the end of 2011, a total of 211 farmers, family members and employees were included in the study. Primary outcome and secondary outcome measures Nasal swabs were taken from participants on days 0, 4, 7 and week 12. A persistent MRSA carrier was defined as a person positive for MRSA on days 0, 4 and 7. Participants filled in an extensive questionnaire to identify potential risk factors and confounders. For estimation of MRSA prevalence in calves and environmental contamination, animal nasal swabs and Electrostatic Dust Collectors were taken on day 0 and week 12. Results The presence of potential animal reservoirs (free-ranging farm cats and sheep) and the level of contact with veal calves was positively associated with persistent MRSA carriage. Interestingly, at the end of the study (week 12), there was a twofold rise in animal prevalence and a significantly higher MRSA environmental load in the stables was found on farms with MRSA carriers. Conclusions This study supports the hypothesis that environmental contamination with MRSA plays a role in the acquisition of MRSA in farmers and their household members and suggests that other animal species should also be targeted to implement effective control strategies. PMID:24056480

  11. Prevalence and properties of mecC methicillin-resistant Staphylococcus aureus (MRSA) in bovine bulk tank milk in Great Britain

    PubMed Central

    Paterson, G. K.; Morgan, F. J. E.; Harrison, E. M.; Peacock, S. J.; Parkhill, J.; Zadoks, R. N.; Holmes, M. A.

    2014-01-01

    Objectives mecC methicillin-resistant Staphylococcus aureus (MRSA) represent a newly recognized form of MRSA, distinguished by the possession of a divergent mecA homologue, mecC. The first isolate to be identified came from bovine milk, but there are few data on the prevalence of mecC MRSA among dairy cattle. The aim of this study was to conduct a prevalence study of mecC MRSA among dairy farms in Great Britain. Methods Test farms were randomly selected by random order generation and bulk tank samples were tested for the presence of mecC MRSA by broth enrichment and plating onto chromogenic agar. All MRSA isolated were screened by PCR for mecA and mecC, and mecC MRSA were further characterized by multilocus sequence typing, spa typing and antimicrobial susceptibility testing. Results mecC MRSA were detected on 10 of 465 dairy farms sampled in England and Wales (prevalence 2.15%, 95% CI 1.17%–3.91%), but not from 625 farms sampled in Scotland (95% CI of prevalence 0%–0.61%). Seven isolates belonged to sequence type (ST) 425, while the other three belonged to clonal complex 130. Resistance to non-β-lactam antibiotics was uncommon. All 10 isolates produced a negative result by slide agglutination for penicillin-binding protein 2a. mecA MRSA ST398 was detected on one farm in England. Conclusions mecC MRSA is widely distributed among dairy farms in Great Britain, but this distribution is not uniform across the whole country. These results provide an important baseline dataset to monitor the epidemiology of this emerging form of MRSA. PMID:24155057

  12. Lack of association of mercury with risk of wheeze and eczema in Japanese children: the Osaka Maternal and Child Health Study.

    PubMed

    Miyake, Yoshihiro; Tanaka, Keiko; Yasutake, Akira; Sasaki, Satoshi; Hirota, Yoshio

    2011-11-01

    Mercury can have profound and complicated effects on the immune system, and epidemiological evidence regarding the relationship between mercury exposure and allergic disorders has been sparse. We investigated the associations between mercury levels in maternal and children's hair and the risk of wheeze and eczema in Japanese children at 29-39 months of age. Study subjects were 582 Japanese mother-child pairs. Presence or absence of wheeze and eczema symptoms was determined based on the criteria of the International Study of Asthma and Allergies in Childhood. Adjustment was made for maternal age; residential municipality at baseline; maternal and paternal education; maternal and paternal history of allergic disorders; maternal energy-adjusted fish intake during pregnancy; maternal smoking during pregnancy; number of child's older siblings; child's sex; household smoking in the same room as the child; breastfeeding duration; and children's fish intake at the fourth survey. The prevalence of wheeze and eczema was 18.6% and 17.2%, respectively. The range of hair mercury levels was 0.26-6.05 μg/g in mothers and 0.13-9.51 μg/g in children. Neither maternal nor children's hair mercury levels were related to the risk of wheeze or eczema. Maternal and children's hair mercury levels in the second quartile were non-significantly inversely related to the risk of wheeze (adjusted odds ratios [95% confidence intervals] were 0.77 [0.41-1.44] and 0.57 [0.29-1.11], respectively) while those in the third quartile were non-significantly inversely associated with the risk of eczema (adjusted odds ratios [95% confidence intervals] were 0.77 [0.40-1.45] and 0.66 [0.33-1.30], respectively). The current study provides no evidence that hair mercury levels in either mothers or children are positively associated with the risk of wheeze or eczema in children aged 29-39 months in Japan, where fish intake is high. PMID:21807364

  13. Asthma, Allergy and Eczema among Adults in Multifamily Houses in Stockholm (3-HE Study) - Associations with Building Characteristics, Home Environment and Energy Use for Heating

    PubMed Central

    Norbäck, Dan; Lampa, Erik; Engvall, Karin

    2014-01-01

    Risk factors for asthma, allergy and eczema were studied in a stratified random sample of adults in Stockholm. In 2005, 472 multifamily buildings (10,506 dwellings) were invited (one subject/dwelling) and 7,554 participated (73%). Associations were analyzed by multiple logistic regression, adjusting for gender, age, smoking, country of birth, income and years in the dwelling. In total, 11% had doctor's diagnosed asthma, 22% doctor's diagnosed allergy, 23% pollen allergy and 23% eczema. Doctor's diagnosed asthma was more common in dwellings with humid air (OR = 1.74) and mould odour (OR = 1.79). Doctor's diagnosed allergy was more common in buildings with supply exhaust air ventilation as compared to exhaust air only (OR = 1.45) and was associated with redecoration (OR = 1.48) and mould odour (OR = 2.35). Pollen allergy was less common in buildings using more energy for heating (OR = 0.75) and was associated with humid air (OR = 1.76) and mould odour (OR = 2.36). Eczema was more common in larger buildings (OR 1.07) and less common in buildings using more energy for heating (OR = 0.85) and was associated with water damage (OR = 1.47), humid air (OR = 1.73) and mould odour (OR = 2.01). Doctor's diagnosed allergy was less common in buildings with management accessibility both in the neighbourhood and in larger administrative divisions, as compared to management in the neighbourhood only (OR = 0.49; 95% CI 0.29–0.82). Pollen allergy was less common if the building maintenance was outsourced (OR = 0.67; 95% CI 0.51–0.88). Eczema was more common when management accessibility was only at the division level (OR = 1.49; 95% CI 1.06–2.11). In conclusions, asthma, allergy or eczema were more common in buildings using less energy for heating, in larger buildings and in dwellings with redecorations, mould odour, dampness and humid air. There is a need to reduce indoor chemical emissions and to control dampness. Energy saving may have consequences for allergy and eczema. More epidemiological studies are needed on building management organization. PMID:25479551

  14. Novel Structures and Temporal Changes of Arginine Catabolic Mobile Elements in Methicillin-Resistant Staphylococcus aureus Genotypes ST5-MRSA-II and ST764-MRSA-II in Japan.

    PubMed

    Urushibara, Noriko; Kawaguchiya, Mitsuyo; Onishi, Mayumi; Mise, Keiji; Aung, Meiji Soe; Kobayashi, Nobumichi

    2016-05-01

    Twenty-two of 1,103 methicillin-resistant Staphylococcus aureus (MRSA) isolates containing the type II staphylococcal cassette chromosome mec element (SCCmec) (collected in Hokkaido, Japan, from 2008 to 2011) harbored the arginine catabolic mobile element (ACME). Five genetic variations were identified in the ACME-staphylococcal cassette chromosome mec composite islands, 66 to 79 kb in size. The percentage of ACME carriage temporally increased from 0.85% to 4.5% in parallel with the emergence of shorter variants (66 to 72 kb). Shorter variants may have a selective advantage and accelerate the dissemination of ACME in Japanese MRSA. PMID:26856835

  15. A lean Six Sigma team increases hand hygiene compliance and reduces hospital-acquired MRSA infections by 51%.

    PubMed

    Carboneau, Clark; Benge, Eddie; Jaco, Mary T; Robinson, Mary

    2010-01-01

    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

  16. Discovery of Novel Wall Teichoic Acid Inhibitors as Effective anti-MRSA β-lactam Combination Agents

    PubMed Central

    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

    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 β-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 β-lactam combination agents. This work also highlights the emerging role of whole genome sequencing in antibiotic mode-of-action and resistance studies. PMID:23438756

  17. Estimating the prevalence of aero-allergy and/or food allergy in infants, children and young people with moderate-to-severe atopic eczema/dermatitis in primary care: multi-centre, cross-sectional study

    PubMed Central

    Sheikh, Aziz

    2015-01-01

    Objective We sought to determine the primary care-based prevalence of moderate-to-severe atopic eczema/dermatitis in children and to estimate what proportion had co-morbid aero-allergy and/or food allergy that was contributing to their atopic eczema/dermatitis. Design Multi-centre, cross-sectional study. Participants Infants, children and young people aged between 0–17 years. Setting Primary Care. Methods General practice electronic health records were interrogated to identify children (0–17 years) with current moderate-to-severe atopic eczema/dermatitis. Eligible children were assessed by an allergy specialist nurse, this involving a detailed allergy history, examination and, if appropriate, measurement of total IgE and specific IgE to relevant aero-allergens and/or food allergens. Main outcome measures Prevalence of atopic eczema, moderate to severe atopic eczema, IgE-mediated atopic eczema. Results We recruited eight practices, which together enrolled 16,877 children. Of these, 4331 (25.7%; 95% CI 25.0, 26.3) children had a recorded diagnosis of atopic eczema/dermatitis and 1316 (7.8%; 95% CI 7.4, 8.2) had treatment indicative of current moderate-to-severe atopic eczema/dermatitis. We recruited 159 children for clinical assessment, and complete data were available for 157. The clinical assessment revealed that 130/157 (82.8%) had no indication of IgE-mediated allergy contributing to their atopic eczema/dermatitis; the remaining 27/157 (17.2%; 95% CI 12.1, 23.9) were on clinical assessment considered to possibly have underlying IgE-mediated disease. Specific IgE tests were positive in 14/27 (51.9%; 95% CI 34.0, 69.3) children. Of the 14 children who tested positive, six (42.9%; 95% CI 21.4, 67.4) were positive to food allergens and six (42.9%; 95% CI 21.4, 67.4) to aero-allergens; the remaining two (14.3%; 95% CI 4.0, 40.0) were positive to both food and aero-allergens. Conclusions Although atopic eczema/dermatitis is a very common diagnosis in children in primary care, most appear to be relatively mild and/or transient. Only a small proportion of children had evidence of ongoing underlying IgE-mediated atopic eczema/dermatitis. PMID:25567768

  18. Isolation of a potent antibiotic producer bacterium, especially against MRSA, from northern region of the Persian Gulf

    PubMed Central

    Darabpour, Esmaeil; Ardakani, Mohammad Roayaei; Motamedi, Hossein; Ronagh, Mohammad Taghi

    2012-01-01

    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. Pseudoalteromonaspiscicida 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

  19. Isolation of a potent antibiotic producer bacterium, especially against MRSA, from northern region of the Persian Gulf.

    PubMed

    Darabpour, Esmaeil; Roayaei Ardakani, Mohammad; Motamedi, Hossein; Taghi Ronagh, Mohammad

    2012-05-01

    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

  20. Detection of methicillin-resistant Staphylococcus aureus (MRSA) using the NanoLantern Biosensor

    NASA Astrophysics Data System (ADS)

    Strohsahl, Christopher M.; Miller, Benjamin L.; Krauss, Todd D.

    2009-02-01

    Staphylococcus aureus is a leading cause of human illness, and has developed the remarkable ability to resist the bactericidal capabilities of many of the world's leading antibiotics (i.e. MRSA). In an effort to enable rapid detection and treatment of MRSA infections, we have developed a DNA detection technology termed the NanoLantern(TM). The NanoLantern(TM) biosensor technology is based on the simple immobilization of a fluorophore-terminated DNA hairpin onto a gold chip. This produces a label-free sensor that allows for a positive response to be obtained without extensive processing of the sample, saving cost and increasing accuracy. We will also discuss a newly developed method of partial gene analysis, used to develop a DNA hairpin probe that is capable of detecting the presence of the mecR gene, a gene necessary for methicillin resistance to be present in S. aureus, with 100% sequence specificity. The successful incorporation of this probe into the NanoLantern(TM) platform, along with the concomitant development of the paired PCR assay has allowed for the successful detection of methicillin-resistance directly from a culture of S. aureus. These results represent an important step forward in terms of developing the ability to rapidly and effectively detect the presence of antibiotic resistance in bacterial infections.

  1. Antibacterial effect of essential oils from two medicinal plants against Methicillin-resistant Staphylococcus aureus (MRSA).

    PubMed

    Tohidpour, A; Sattari, M; Omidbaigi, R; Yadegar, A; Nazemi, J

    2010-02-01

    Antimicrobial properties of plants essential oils (EOs) have been investigated through several observations and clinical studies which purpose them as potential tools to overcome the microbial drug resistance problem. The aim of this research is to study the antibacterial effect of two traditional plants essential oils, Thymus vulgaris and Eucalyptus globulus against clinical isolates of Methicillin resistant Staphylococcus aureus (MRSA) and other standard bacterial strains through disk diffusion and agar dilution methods. Gas Chromatography (GC) and Gas Chromatography/Mass Spectrometry (GC/MS) analysis examined the chemical composition of the oils. Results revealed both of oils to possess degrees of antibacterial activity against Gram (+) and Gram (-) bacteria. T. vulgaris EO showed better inhibitory effects than E. globulus essential oil. GC analysis of T. vulgaris resulted in thymol as the oil major compound whereas GC/MS assay exhibited eucalyptol as the most abundant constitute of E. globulus EO. These results support previous studies on these oils and suggest an additional option to treat MRSA infections. Clinical and further analytical trials of these data are necessary to confirm the obtained outcomes. PMID:19576738

  2. Effects of passage number on growth and productivity of hybridoma secreting MRSA anti-PBP2a monoclonal antibodies.

    PubMed

    Corrêa, Arthur Luiz; Senna, José Procópio Moreno; de Sousa, Álvaro Paiva Braga

    2016-05-01

    Monoclonal antibodies (mAb) are high added value glycoproteins recommended for immunotherapy, diagnosis, and also for the treatment of bacterial infections resistant to multiple drugs such as Methicillin Resistant Staphylococcus aureus (MRSA). In addition to environmental conditions related to cell cultures, the intrinsic characteristics of hybridoma cells, like the secretion stability of monoclonal antibodies by the cells through successive subcultures, are relevant for the characterization of cell lines related to the productivity of mAb. The rate of mAb production differs significantly between different cell lines and different passage numbers, and it is an important variable in characterization of cell lines. In order to find a more robust, faster-growing, and higher-productivity cell line of hybridoma, cultivations in 24-well plates were performed in different subculture periods, or cell passages (P), of hybridoma cells producing MRSA anti-PBP2a monoclonal antibodies [MRSA-antiPBP2a (mAb)]. The objective of this study was to study the effects of cell growth and production of MRSA-antiPBP2a mAb secreted by murine hybridoma cells grown in different passages as well as determine the which passages the hybridomas can be cultivated without harming their growth and productivity. So, cell growth profiles of hybridomas secreting MRSA-antiPBP2a (mAb) and the production of MRSA-antiPBP2a mAb in different subculture periods or cell passages (P) were studied. Cell growth tests, monoclonal antibody productivity, and metabolite characteristics revealed substantial differences in those cells kept between P10 and P50. Similarities in the secretion of monoclonal antibody, growth, and metabolic profiles, were noted in the MRSA-antiPBP2a mAb producing hybridoma cells kept between P10 and P20. Also, glucose consumption (g/L) and lactate production (g/L) in the latter cell cultures were monitored daily through biochemical analyzer. As of P30, it was observed a 4.4 times reduction in productivity, a 13 % reduction in metabolic yield, and a significant change in cell growth. Secretion of MRSA-antiPBP2a mAb should be obtained through the culture of hybridomas up to P20 in order to keep its stability. PMID:26093480

  3. Absence of human innate immune evasion complex in LA-MRSA ST5 strains isolated from pigs, swine facilities, and humans with swine contact

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Background: Since its first ties to swine, livestock associated methicillin-resistant Staphylococcus aureus (LA-MRSA) has raised public health concerns because livestock may be the largest reservoir of MRSA outside the hospital setting. In contrast to Europe and Asia, where the primary sequence type...

  4. 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

    Buss, Bryan F.; Connolly, Susan

    2014-01-01

    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…

  5. 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

    Buss, Bryan F.; Connolly, Susan

    2014-01-01

    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

  6. Nasal carriage of methicillin-resistant Staphylococcus aureus (MRSA) among Swiss veterinary health care providers: detection of livestock- and healthcare-associated clones.

    PubMed

    Wettstein Rosenkranz, K; Rothenanger, E; Brodard, I; Collaud, A; Overesch, G; Bigler, B; Marschall, J; Perreten, V

    2014-07-01

    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, β-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

  7. PS2-36: Population-based Evaluation of Patients with Methicillin-resistant Staphylococcus aureus (MRSA) Infection in Relation to Animal Feeding Operations in Pennsylvania

    PubMed Central

    Schwartz, Brian; Pollak, Jonathan; Mercer, Dione; DeWalle, Joseph; Stewart, Walter

    2011-01-01

    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.

  8. Severe eczema and Hyper-IgE in Loeys-Dietz-syndrome - contribution to new findings of immune dysregulation in connective tissue disorders.

    PubMed

    Felgentreff, Kerstin; Siepe, Matthias; Kotthoff, Stefan; von Kodolitsch, Yskert; Schachtrup, Kristina; Notarangelo, Luigi D; Walter, Jolan E; Ehl, Stephan

    2014-01-01

    Loeys-Dietz syndrome (LDS) is a connective tissue disorder caused by monoallelic mutations in TGFBR1 and TGFBR2, which encode for subunits of the transforming growth factor beta (TGFβ) receptor. Affected patients are identified by vascular aneurysms with tortuosity and distinct morphological presentations similar to Marfan syndrome; however, an additional predisposition towards asthma and allergy has recently been found. We describe two patients with a novel missense mutation in TGFBR1 presenting with highly elevated levels of IgE and severe eczema similar to autosomal-dominant Hyper-IgE syndrome (HIES). Mild allergic manifestations with normal up to moderately increased IgE were observed in 3 out of 6 additional LDS patients. A comparison of this cohort with 4 HIES patients illustrates the significant overlap of both syndromes including eczema and elevated IgE as well as skeletal and connective tissue manifestations. PMID:24333532

  9. Association of prevalence of rhinitis, atopic eczema, rhinoconjunctivitis and wheezing with mortality from infectious diseases and with antibiotic susceptibility at a country level

    PubMed Central

    Fsadni, Peter; Fava, Stephen; Montefort, Stephen

    2015-01-01

    Background It was previously reported that there is a positive correlation between incidence of type 1 diabetes and prevalence of asthma and atopic eczema. A negative correlation between the prevalence of type 1 diabetes and mortality from infectious diseases as well as a positive correlation with antibiotic susceptibility at a country level have also been reported. Objective The aim of this study was to investigate the association between country prevalence of rhinitis, atopic eczema, rhinoconjunctivitis, and wheezing with mortality from infectious diseases and also with antibiotic susceptibility at a country level. Methods Data for prevalence of rhinitis, eczema, rhinoconjunctivitis, and wheezing was obtained from the International Study of Asthma and Allergies in Childhood study (ISAAC). ISAAC Phase one was a multicentre multicountry cross sectional study involving over 700,000 children in 2 age groups of school children, 13-14 years old (adolescents) and 6-7 years old (children) in 156 centres from 56 countries. Mortality from infectious diseases was taken from World Health Organisation data. The Alexander project was used to identify antibiotic susceptibilities to common bacteria. Results There were significant positive correlations between atopic eczema and mortality from all infectious diseases studied, diarrhoeal illness, tropical infections, and childhood infections. A negative correlation exists between the prevalence of rhinitis and Streptococcus pneumoniae susceptibility to penicillin and to erythromycin, rhinitis and Haemophilus influenzae susceptibility to ampicillin and between rhinoconjunctivitis and H. influenzae susceptibility to ampicillin. Conclusion Th1/Th2 responses might influence the pathogenesis of infectious disease mortality, while antibiotic overprescription could explain the negative association between atopy and antibiotic susceptibility. PMID:26240791

  10. An overview of skin scores used for quantifying hand eczema: a critical update according to the criteria of evidence-based medicine.

    PubMed

    Weistenhöfer, W; Baumeister, T; Drexler, H; Kütting, B

    2010-02-01

    The present review gives an overview of the enormous variety of skin scores used for assessing severity in patients suffering from hand eczema. In order to evaluate the validity and practical relevance of different scoring systems according to the criteria of evidence-based medicine, in May 2009 we performed a systematic search of the literature using PubMed and the Cochrane Library. A total of 69 articles reporting on 45 different methods for quantifying hand eczema were identified. The panel of methods varied from pure subjective categories to more or less quantitative scoring systems. Furthermore, by focusing on skin scores used in clinical trials in which the results led to the licensing of a systemic or topical drug for treatment of hand eczema, a panel of different scoring systems was identified. In addition to morphological pattern, some scoring systems included subjective complaints, which might cause an individual bias by overestimation of self-reports. Inter- and intraobserver reliability was rarely reported except for three scores. Among these validated scores interobserver reliability was reported for three scores, but only one of the three included reliability within observers (repeatability). Advantages and disadvantages of the different scoring systems are critically discussed. Depending on different indications and particular settings (e.g. occupational screening vs. clinical examinations, evaluating progress of treatment in everyday clinical practice or for research purposes) scoring systems have to fulfil diverging demands. We draw the conclusion that a standardized diagnostic procedure for assessing the severity of hand eczema would facilitate the comparability of outcome of clinical trials. However, scoring systems used for occupational screening have to fulfil different demands compared with scoring systems used for licensing of drugs. This striking difference might be explained by the skin condition, which is generally supposed to be much better in subjects at medical check-ups at the workplace. PMID:19785600

  11. Studying the time trend of Methicillin-resistant Staphylococcus aureus (MRSA) in Norway by use of non-stationary γ-Poisson distributions

    PubMed Central

    Moxnes, John F; Moen, Aina E Fossum; Leegaard, Truls Michael

    2015-01-01

    Objectives Study the time development of methicillin-resistant Staphylococcus aureus (MRSA) and forecast future behaviour. The major question: Is the number of MRSA isolates in Norway increasing and will it continue to increase? Design Time trend analysis using non-stationary γ-Poisson distributions. Setting Two data sets were analysed. The first data set (data set I) consists of all MRSA isolates collected in Oslo County from 1997 to 2010; the study area includes the Norwegian capital of Oslo and nearby surrounding areas, covering approximately 11% of the Norwegian population. The second data set (data set II) consists of all MRSA isolates collected in Health Region East from 2002 to 2011. Health Region East consists of Oslo County and four neighbouring counties, and is the most populated area of Norway. Participants Both data sets I and II consist of all persons in the area and time period described in the Settings, from whom MRSA have been isolated. Primary and secondary outcome measures MRSA infections have been mandatory notifiable in Norway since 1995, and MRSA colonisation since 2004. In the time period studied, all bacterial samples in Norway have been sent to a medical microbiological laboratory at the regional hospital for testing. In collaboration with the regional hospitals in five counties, we have collected all MRSA findings in the South-Eastern part of Norway over long time periods. Results On an average, a linear or exponential increase in MRSA numbers was observed in the data sets. A Poisson process with increasing intensity did not capture the dispersion of the time series, but a γ-Poisson process showed good agreement and captured the overdispersion. The numerical model showed numerical internal consistency. Conclusions In the present study, we find that the number of MRSA isolates is increasing in the most populated area of Norway during the time period studied. We also forecast a continuous increase until the year 2017. PMID:26438133

  12. 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

    Kannan, Rajaretinam Rajesh; Iniyan, Appadurai Muthamil; Prakash, Vincent Samuel Gnana

    2011-01-01

    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. PMID:23569790

  13. Adjustment of the MRSA Search and Destroy policy for outpatients in the Netherlands: a prospective cohort study with repeated prevalence measurements

    PubMed Central

    2014-01-01

    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. PMID:24428940

  14. Molecular Epidemiology of Methicillin-Resistant Staphylococcus aureus (MRSA) among Patients Admitted to Adult Intensive Care Units: the STAR*ICU Trial

    PubMed Central

    Nair, Nisha; Kourbatova, Ekaterina; Poole, Katharine; Huckabee, Charmaine M.; Murray, Patrick; Huskins, W. Charles; Blumberg, Henry M.

    2014-01-01

    Background The multi-center cluster-randomized Strategies to Reduce Transmission of Antimicrobial Resistant Bacteria in Intensive Care Units (STAR*ICU) trial was carried out in 18 U.S. adult intensive care units (ICUs) and evaluated the effectiveness of infection control strategies in reducing transmission of methicillin-resistant Staphylococcus aureus (MRSA) colonization and/or infection. Our study objective was to examine the molecular epidemiology of MRSA and assess the prevalence and risk factors for community acquired (CA)-MRSA genotype nasal carriage at the time of ICU admission. Methods Selected MRSA isolates were subjected to molecular typing using pulsed-field gel electrophoresis. Results Among 5,512 ICU patient-admissions in the STAR*ICU trial during the intervention period, 626 (11%) had a positive nares culture for MRSA. 210/626 (34%) available isolates were selected by weighted random sampling for molecular typing. Of 210 patients, 123 (59%) were male; mean age was 63 years. Molecular typing revealed that 147 isolates (70%) were the USA100 clone; 26 (12%) USA300; 12 (6%) USA500; 8 (4%) USA800; 17 (8%) other. In multivariate analysis, patients with CA-MRSA genotype (USA300, USA400, or USA1000) colonization were less likely to have been hospitalized during the previous 12 months (PR=0.39; 95% C.I. 0.21–0.73) and less likely to have an older age (PR=0.97 per year; 0.95–0.98) compared to patients with a HA-MRSA genotype. Conclusion CA-MRSA genotypes have emerged as a cause of MRSA nares colonization among patients admitted to adult ICUs in the U.S. During the study period (2006), the predominant site of CA-MRSA genotype acquisition appeared to be in the community. PMID:22011531

  15. Performance of CHROMagar Staph aureus and CHROMagar MRSA for detection of Staphylococcus aureus in seawater and beach sand--comparison of culture, agglutination, and molecular analyses.

    PubMed

    Goodwin, K D; Pobuda, M

    2009-11-01

    Beach seawater and sand were analyzed for Staphylococcus aureus and methicillin resistant S. aureus (MRSA) for samples collected from Avalon, and Doheny Beach, CA. Membrane filtration followed by incubation on CHROMagar Staph aureus (SCA) and CHROMagar MRSA (C-MRSA) was used to enumerate S. aureus and MRSA, respectively. Media performance was evaluated by comparing identification via colony morphology and latex agglutination tests to PCR (clfA, 16S, and mecA genes). Due to background color and crowding, picking colonies from membrane filters and streaking for isolation were sometimes necessary. The specificity of SCA and C-MRSA was improved if colony isolates were identified by the presence of a matte halo in addition to mauve color; however routine agglutination testing of isolates did not appear warranted. Using the appearance of a colony on the membrane filter in conjunction with isolate appearance, the positive % agreement, the negative % agreement, and the % positive predictive accuracy for SCA was 84%, 95%, and 99% respectively, and for C-MRSA it was 85%, 98%, and 92%, respectively. Sensitivity and specificity of SCA and C-MRSA with membrane-filtered beach samples were optimized through identification experience, control of filter volume and incubation time, and isolation of colonies needing further identification. With optimization, SCA and C-MRSA could be used for enumeration of S. aureus and MRSA from samples of beach water and sand. For the sites studied here, the frequency of detection of S. aureus ranged from 60 to 76% and 53 to 79% for samples of beach seawater and sand, respectively. The frequency of detection of MRSA ranged from 2 to 9% and 0 to 12% for samples of seawater and sand, respectively. PMID:19577788

  16. Exclusive or Partial Breastfeeding for 6 Months Is Associated With Reduced Milk Sensitization and Risk of Eczema in Early Childhood: The PATCH Birth Cohort Study.

    PubMed

    Chiu, Chih-Yung; Liao, Sui-Ling; Su, Kuan-Wen; Tsai, Ming-Han; Hua, Man-Chin; Lai, Shen-Hao; Chen, Li-Chen; Yao, Tsung-Chieh; Yeh, Kuo-Wei; Huang, Jing-Long

    2016-04-01

    There is insufficient evidence to confirm the association between breastfeeding and allergic outcomes later in life. This study aimed to determine the relationships between different breastfeeding patterns and allergen sensitizations and risk of developing atopic diseases in early childhood. A total of 186 children from a birth cohort in the Prediction of Allergies in Taiwanese Children study for a 4-year follow-up period were enrolled. Total serum immunoglobulin E (IgE) levels and specific IgE antibodies against food and inhalant allergens were measured sequentially at 6 months as well as at 1, 1.5, 2, 3, and 4 years of age. A significantly lower prevalence of milk sensitization was found in children at ages 1 and 1.5 years who were exclusively or partially breastfed for ≥6 months. Breastfeeding ≥6 months was significantly associated with a reduced risk of developing eczema but not allergic rhinitis and asthma at ages 1 and 2 years. Compared with exclusive breastfeeding ≥6 months, partial breastfeeding <6 months was significantly associated with an increased risk of developing eczema at ages 1 and 2 years. As with exclusive breastfeeding, partial breastfeeding for at least 6 months appears to be associated with a reduced prevalence of milk sensitization as well as a reduced risk of developing eczema in early childhood. PMID:27082611

  17. Comparative prevalence of immune evasion complex genes associated with beta-hemolysin converting bacteriophages in MRSA ST5 isolates from swine, swine facilities, humans with swine contact, and humans with no swine contact

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Livestock associated methicillin-resistant Staphylococcus aureus (LA-MRSA) draws concern from the public health community because in some countries these organisms may represent the largest reservoir of MRSA outside hospital settings. Recent studies indicate LA-MRSA strains from swine are more genet...

  18. Ceftobiprole: a review of a broad-spectrum and anti-MRSA cephalosporin.

    PubMed

    Zhanel, George G; Lam, Ashley; Schweizer, Frank; Thomson, Kristjan; Walkty, Andrew; Rubinstein, Ethan; Gin, Alfred S; Hoban, Daryl J; Noreddin, Ayman M; Karlowsky, James A

    2008-01-01

    Ceftobiprole, an investigational cephalosporin, is currently in phase III clinical development. Ceftobiprole is a broad-spectrum cephalosporin with demonstrated in vitro activity against Gram-positive cocci, including meticillin-resistant Staphylococcus aureus (MRSA) and meticillin-resistant S. epidermidis, penicillin-resistant S. pneumoniae, Enterococcus faecalis, Gram-negative bacilli including AmpC-producing Escherichia coli and Pseudomonas aeruginosa, but excluding extended-spectrum beta-lactamase-producing strains. Like cefotaxime, ceftriaxone, ceftazidime, and cefepime, ceftobiprole demonstrates limited activity against anaerobes such as Bacteroides fragilis and non-fragilis Bacteroides spp. In single-step and serial passage in vitro resistance development studies, ceftobiprole demonstrated a low propensity to select for resistant subpopulations. Ceftobiprole, like cefepime, is a weak inducer and a poor substrate for AmpC beta-lactamases.Ceftobiprole medocaril, the prodrug of ceftobiprole, is converted by plasma esterases to ceftobiprole in <30 minutes. Peak serum concentrations of ceftobiprole observed at the end of a single 30-minute infusion were 35.5 mug/mL for a 500-mg dose and 59.6 mug/mL for a 750-mg dose. The volume of distribution of ceftobiprole is 0.26 L/kg ( approximately 18 L), protein binding is 16%, and its serum half-life is approximately 3.5 hours. Ceftobiprole is renally excreted ( approximately 70% in the active form) and systemic clearance correlates with creatinine clearance, meaning that dosage adjustment is required in patients with renal dysfunction. Ceftobiprole has a modest post-antibiotic effect (PAE) of approximately 0.5 hours for MRSA and a longer PAE of approximately 2 hours for penicillin-resistant pneumococci. Ceftobiprole, when administered intravenously at 500 mg once every 8 hours (2-hour infusion), has a >90% probability of achieving f T(>MIC) (free drug concentration exceeds the minimum inhibitory concentration [MIC]) for 40% and 60%, respectively, of the dosing interval for isolates with ceftobiprole MIC < or =4 and < or =2 mg/L, respectively.Currently, only limited clinical trial data are published for ceftobiprole. In a phase III trial, 784 patients with Gram-positive skin infections were randomized to treatment with either ceftobiprole 500 mg or vancomycin 1 g, each administered twice daily for 7-14 days; 93.3% of patients were clinically cured with ceftobiprole compared with 93.5% receiving vancomycin, and the eradication rate for MRSA infections was 91.8% for ceftobiprole compared with 90% for vancomycin. A phase III, randomized, double-blind, multicenter trial compared ceftobiprole 500 mg every 8 hours with vancomycin 1 g every 12 hours plus ceftazidime 1 g every 8 hours in patients with complicated skin and skin structure infections. Of the 828 patients enrolled, 31% had diabetic foot infections, 30% had abscesses, and 22% had wounds. No difference in clinical cure was reported in the clinically evaluable, intent-to-treat and microbiologically evaluable populations with cure rates of 90.5%, 81.9%, and 90.8%, respectively, in the ceftobiprole-treated patients and 90.2%, 80.8%, and 90.5%, respectively, in the vancomycin plus ceftazidime-treated group. Microbiologic eradication of Gram-positive cocci meticillin-susceptible S. aureus (MSSA) [ceftobiprole 91% vs vancomycin plus ceftazidime 92%] and MRSA (ceftobiprole 87% vs vancomycin plus ceftazidime 80%), as well as Gram-negative bacilli, E. coli (ceftobiprole 89% vs vancomycin plus ceftazidime 92%), and P. aeruginosa (ceftobiprole 87% vs vancomycin plus ceftazidime 100%), was not significantly different between groups. Similar cures rates in the microbiologically evaluable population occurred in both groups for Panton-Valentine leukocidin (PVL)-positive MSSA and PVL-positive MRSA.Currently, ceftobiprole has completed phase III trials for complicated skin and skin structure infections due to MRSA and nosocomial pneumonia due to suspected or proven MRSA; phase III trials are also ongoing in community-acquired pneumonia. Ceftobiprole has so far demonstrated a good safety profile in preliminary studies with similar tolerability to comparators. The broad-spectrum activity of ceftobiprole may allow it to be used as monotherapy in situations where a combination of antibacterials might be required. Further clinical studies are needed to determine the efficacy and safety of ceftobiprole and to define its role in patient care. PMID:18572975

  19. Development of Eczema Vaccinatum in Atopic Mouse Models and Efficacy of MVA Vaccination against Lethal Poxviral Infection

    PubMed Central

    Knitlova, Jarmila; Hajkova, Vera; Voska, Ludek; Elsterova, Jana; Obrova, Barbora; Melkova, Zora

    2014-01-01

    Smallpox vaccine based on live, replicating vaccinia virus (VACV) is associated with several potentially serious and deadly complications. Consequently, a new generation of vaccine based on non-replicating Modified vaccinia virus Ankara (MVA) has been under clinical development. MVA seems to induce good immune responses in blood tests, but it is impossible to test its efficacy in vivo in human. One of the serious complications of the replicating vaccine is eczema vaccinatum (EV) occurring in individuals with atopic dermatitis (AD), thus excluding them from all preventive vaccination schemes. In this study, we first characterized and compared development of eczema vaccinatum in different mouse strains. Nc/Nga, Balb/c and C57Bl/6J mice were epicutaneously sensitized with ovalbumin (OVA) or saline control to induce signs of atopic dermatitis and subsequently trans-dermally (t.d.) immunized with VACV strain Western Reserve (WR). Large primary lesions occurred in both mock- and OVA-sensitized Nc/Nga mice, while they remained small in Balb/c and C57Bl/6J mice. Satellite lesions developed in both mock- and OVA-sensitized Nc/Nga and in OVA-sensitized Balb/c mice with the rate 40–50%. Presence of mastocytes and eosinophils was the highest in Nc/Nga mice. Consequently, we have chosen Nc/Nga mice as a model of AD/EV and tested efficacy of MVA and Dryvax vaccinations against a lethal intra-nasal (i.n.) challenge with WR, the surrogate of smallpox. Inoculation of MVA intra-muscularly (i.m.) or t.d. resulted in no lesions, while inoculation of Dryvax t.d. yielded large primary and many satellite lesions similar to WR. Eighty three and 92% of mice vaccinated with a single dose of MVA i.m. or t.d., respectively, survived a lethal i.n. challenge with WR without any serious illness, while all Dryvax-vaccinated animals survived. This is the first formal prove of protective immunity against a lethal poxvirus challenge induced by vaccination with MVA in an atopic organism. PMID:25486419

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

    PubMed Central

    2010-01-01

    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 items organised in six dimensions was tested on a pilot sample of patients to assess its legibility. The extended version was then tested on a sample of 217 patients of both genders enrolled at 18 hospitals representative of the national distribution. The questionnaire was supplied together with the Morisky-Green compliance questionnaire, the health-related quality of life (HRQL) SF-12 questionnaire, and a visual analogue scale (VAS) of perceived health status to assess concurrent validity. The dimensionality was reduced by means of exploratory factor analysis, and reliability was evaluated on the basis of internal consistency and two halves reliability estimates. Item discriminant capability and questionnaire discriminant validity with respect to known groups of patients (by gender, principal diagnosis, age, disease severity and treatment) were also assessed. Results The reduction and validation sample was composed of 54% women and 46% men, of various educational levels with an average age of 43 years (SD = 13.7). Of those who responded, 26% were diagnosed with hyperkeratotic dermatitis of the palms and 27% of the fingertips, and 47% with recurring palmar dyshidrotic eczema. The questionnaire was shortened to a version containing 17 items grouped in six dimensions: effectiveness, convenience, impact on HRQL, medical follow-up, side effects, and general opinion. Cronbach's alpha coefficient reached a value of 0.9. The dimensions showed different degrees of correlation, and the scores had a normal distribution with an average of 58.4 points (SD = 18.01). Treatment satisfaction scores attained correlations between 0.003 and 0.222 with the HRQL measures, and showed higher correlations with the effectiveness (r = 0.41) and tolerability (0.22) measures, but very low correlation with compliance (r = 0.015). Significant differences were observed between some diagnoses and treatments. Conclusions The shortened questionnaire proved to have good psychometric properties, providing excellent reliability, satisfactorily reproducing the proposed structure and supplying evidence of validity. PMID:21054872

  1. Pharmacokinetic/pharmacodynamic analysis of teicoplanin in patients with MRSA infections

    PubMed Central

    Matsumoto, Kazuaki; Watanabe, Erika; Kanazawa, Naoko; Fukamizu, Tomohide; Shigemi, Akari; Yokoyama, Yuta; Ikawa, Kazuro; Morikawa, Norifumi; Takeda, Yasuo

    2016-01-01

    Background Teicoplanin is a glycopeptide antibiotic that has been used to treat serious, invasive infections caused by Gram-positive bacteria. The area under the drug concentration–time curve (AUC)/minimum inhibitory concentration (MIC) was identified as a pharmacokinetic–pharmacodynamic (PK–PD) parameter of glycopeptide antibiotics that correlated with bacteriological responses and clinical outcomes. Although optimized dosing regimens based on PK–PD are needed, a PK–PD analysis of teicoplanin against methicillin-resistant Staphylococcus aureus (MRSA) infections has not yet been performed. Thus, this study examined patients with MRSA infections, who were administered with teicoplanin in order to determine the target AUC/MIC ratio. Methods This study retrospectively assessed data obtained as part of our routine therapeutic drug monitoring (TDM) of teicoplanin therapy in 46 patients with MRSA infections at Kagoshima University Hospital. Serum concentrations of teicoplanin were determined using a fluorescence polarization immunoassay system and used for a Bayesian PK estimation to estimate AUC for 24 hours (AUC24). The MIC value for teicoplanin was determined using a standardized agar dilution method. The effects of teicoplanin were evaluated in terms of bacteriological responses by a quantitative assessment. Results The estimated AUC24/MIC ratios with and without bacteriological responses were 926.6±425.2 µg·h/mL (n=34) and 642.2±193.9 µg·h/mL, respectively (n=12; P<0.05). On the basis of a logistic regression analysis, AUC24/MIC ratios of 500 µg·h/mL, 700 µg·h/mL, and 900 µg·h/mL gave probabilities of treatment success of 0.50, 0.72, and 0.87, respectively. Furthermore, using the Kaplan–Meier curve analysis, an AUC24/MIC ratio of ≥900 led to a significantly stronger bacteriological response than an AUC24/MIC ratio of <900. Conclusion These results suggest that an AUC24/MIC ratio of ≥900 µg·h/mL is required to ensure a sufficient bacteriological response. PMID:27099534

  2. Spread of Epidemic MRSA-ST5-IV Clone Encoding PVL as a Major Cause of Community Onset Staphylococcal Infections in Argentinean Children

    PubMed Central

    Sola, Claudia; Egea, Ana L.; Moyano, Alejandro J.; Garnero, Analia; Kevric, Ines; Culasso, Catalina; Vindel, Ana; Lopardo, Horacio; Bocco, José L.

    2012-01-01

    Background Community-associated methicillin-resistant Staphylococcus aureus-(CA-MRSA) strains have emerged in Argentina. We investigated the clinical and molecular evolution of community-onset MRSA infections (CO-MRSA) in children of Córdoba, Argentina, 2005–2008. Additionally, data from 2007 were compared with the epidemiology of these infections in other regions of the country. Methodology/Principal Findings Two datasets were used: i) lab-based prospective surveillance of CA-MRSA isolates from 3 Córdoba pediatric hospitals-(CBAH1-H3) in 2007–2008 (compared to previously published data of 2005) and ii) a sampling of CO-MRSA from a study involving both, healthcare-associated community-onset-(HACO) infections in children with risk-factors for healthcare-associated infections-(HRFs), and CA-MRSA infections in patients without HRFs detected in multiple centers of Argentina in 2007. Molecular typing was performed on the CA-MRSA-(n: 99) isolates from the CBAH1-H3-dataset and on the HACO-MRSA-(n: 51) and CA-MRSA-(n: 213) isolates from other regions. Between 2005–2008, the annual proportion of CA-MRSA/CA-S. aureus in Córdoba hospitals increased from 25% to 49%, P<0.01. Total CA-MRSA infections increased 3.6 fold-(5.1 to 18.6 cases/100,000 annual-visits, P<0.0001), associated with an important increase of invasive CA-MRSA infections-(8.5 fold). In all regions analyzed, a single genotype prevailed in both CA-MRSA (82%) and HACO-MRSA(57%), which showed pulsed-field-gel electrophoresis-(PFGE)-type-“I”, sequence-type-5-(ST5), SCCmec-type-IVa, spa-t311, and was positive for PVL. The second clone, pulsotype-N/ST30/CC30/SCCmecIVc/t019/PVL+, accounted for 11.5% of total CA-MRSA infections. Importantly, the first 4 isolates of Argentina belonging to South American-USA300 clone-(USA300/ST8/CC8/SCCmecIVc/t008/PVL+/ACME−) were detected. We also demonstrated that a HA-MRSA clone-(pulsotype-C/ST100/CC5) caused 2% and 10% of CA-MRSA and HACO-MRSA infections respectively and was associated with a SCCmec type closely related to SCCmecIV(2B&5). Conclusions/Significance The dissemination of epidemic MRSA clone, ST5-IV-PVL+ was the main cause of increasing staphylococcal community-onset infections in Argentinean children (2003–2008), conversely to other countries. The predominance of this clone, which has capacity to express the h-VISA phenotype, in healthcare-associated community-onset cases suggests that it has infiltrated into hospital-settings. PMID:22291965

  3. A Population Based Study of Seasonality of Skin and Soft Tissue Infections: Implications for the Spread of CA-MRSA

    PubMed Central

    Wang, Xiaoxia; Towers, Sherry; Panchanathan, Sarada; Chowell, Gerardo

    2013-01-01

    Methicillin resistant Staphylococcus aureus (MRSA) is currently a major cause of skin and soft tissue infections (SSTI) in the United States. Seasonal variation of MRSA infections in hospital settings has been widely observed. However, systematic time-series analysis of incidence data is desirable to understand the seasonality of community acquired (CA)-MRSA infections at the population level. In this paper, using data on monthly SSTI incidence in children aged 0–19 years and enrolled in Medicaid in Maricopa County, Arizona, from January 2005 to December 2008, we carried out time-series and nonlinear regression analysis to determine the periodicity, trend, and peak timing in SSTI incidence in children at different age: 0–4 years, 5–9 years, 10–14 years, and 15–19 years. We also assessed the temporal correlation between SSTI incidence and meteorological variables including average temperature and humidity. Our analysis revealed a strong annual seasonal pattern of SSTI incidence with peak occurring in early September. This pattern was consistent across age groups. Moreover, SSTIs followed a significantly increasing trend over the 4-year study period with annual incidence increasing from 3.36% to 5.55% in our pediatric population of approximately 290,000. We also found a significant correlation between the temporal variation in SSTI incidence and mean temperature and specific humidity. Our findings could have potential implications on prevention and control efforts against CA-MRSA. PMID:23565281

  4. An observational prospective study of topical acidified nitrite for killing methicillin-resistant Staphylococcus aureus (MRSA) in contaminated wounds

    PubMed Central

    2011-01-01

    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. PMID:22032298

  5. Efficacy of Caltropis procera and Ficus sycomorus extracts in treating MRSA (methicillin-resistant Staphylococcus aureus)-keratitis in rabbit

    PubMed Central

    Sayed, Waiel F.; Salem, Wesam M. A.; Haridy, Mohie A. M.; Hassan, Ne'mat H.

    2015-01-01

    MRSA-induced keratitis in rabbit was used to evaluate the therapeutic effect of F. sycomorus leaves and C. procera latex extracts. Within the 6 rabbit groups tested, group 1 received sterilized saline, while other groups (2 to 6) received 100 μl of intrastromal injections of 1.5×103 colony forming unit (cfu) ml-1 of methicillin-resistant Staphylococcus aureus (MRSA). After 12 hours, groups 3 to 6 also received chloramphenicol, aqueous extract of C. procera latex, aqueous and alcoholic extracts of F. sycomorus leaves, respectively 3 times daily for 12 successive days. The tested extracts inhibited MRSA growth in vitro (i.e. on culture medium). Colony counts in cornea discs from groups 3 to 6 were significantly reduced (P ≤ 0.001) compared to group 2 (untreated). Clinical signs of keratitis were observed on group 2 until the end of experiment. In groups 3 to 6, gradual recovery was observed and signs disappeared by the 12th DPI (days post inoculation). Only mild symptoms persisted in group 5 (aqueous extract of leaves). In group 3 and 5, cornea, iris, ciliary body and conjunctiva showed mild leukocytic infiltration and depigmentation of melanin cells while recovery of cornea and iris was observed in groups 4 and 6. In conclusion, the used extracts have potential therapeutic effects on MRSA-induced keratitis in rabbit. PMID:26648824

  6. Virus-Like Particle-Induced Protection Against MRSA Pneumonia Is Dependent on IL-13 and Enhancement of Phagocyte Function

    PubMed Central

    Rynda-Apple, Agnieszka; Dobrinen, Erin; McAlpine, Mark; Read, Amanda; Harmsen, Ann; Richert, Laura E.; Calverley, Matthew; Pallister, Kyler; Voyich, Jovanka; Wiley, James A.; Johnson, Ben; Young, Mark; Douglas, Trevor; Harmsen, Allen G.

    2013-01-01

    The importance of the priming of the lung environment by past infections is being increasingly recognized. Exposure to any given antigen can either improve or worsen the outcome of subsequent lung infections, depending on the immunological history of the host. Thus, an ability to impart transient alterations in the lung environment in anticipation of future insult could provide an important novel therapy for emerging infectious diseases. In this study, we show that nasal administration of virus-like particles (VLPs) before, or immediately after, lethal challenge with methicillin-resistant Staphylococcus aureus (MRSA) of mice i) ensures complete recovery from lung infection and near absolute clearance of bacteria within 12 hours of challenge, ii) reduces host response-induced lung tissue damage, iii) promotes recruitment and efficient bacterial clearance by neutrophils and CD11c+ cells, and iv) protects macrophages from MRSA-induced necrosis. VLP-mediated protection against MRSA relied on innate immunity. Complete recovery occurred in VLP-dosed mice with severe combined immunodeficiency, but not in wild-type mice depleted of either Ly6G+ or CD11c+ cells. Early IL-13 production associated with VLP-induced CD11c+ cells was essential for VLP-induced protection. These results indicate that VLP-induced alteration of the lung environment protects the host from lethal MRSA pneumonia by enhancing phagocyte recruitment and killing and by reducing inflammation-induced tissue damage via IL-13–dependent mechanisms. PMID:22642909

  7. A novel treatment option for MRSA pneumonia: ceftaroline fosamil-yielding new hope in the fight against a persistent infection.

    PubMed

    Arshad, Samia; Hartman, Pamela; Zervos, Marcus J

    2014-07-01

    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

  8. A Molecular Docking and Dynamics Study to Screen Potent Anti-Staphylococcal Compounds Against Ceftaroline Resistant MRSA.

    PubMed

    Lavanya, P; Ramaiah, Sudha; Anbarasu, Anand

    2016-02-01

    World Health Organization reports that methicillin-resistant Staphylococcus aureus (MRSA) is the origin of higher proportion of hospital acquired infections. In order to combat the effect of MRSA infection, an ideal drug should stimulate the allosteric exposure of active site, prompting penicillin binding proteins (PBP2a) to bind with that particular compound. Ceftaroline shows high binding affinity towards PBP2a and also confers resistance against degrading enzymes. Recently, two amino acid alterations in the allosteric site of PBP2a, asparagine (N) to lysine (K) at position 146 and glutamic acid (E) to lysine at position 150 are reported to confer resistance against ceftaroline resulting in the rise of ceftaroline-resistant MRSA strains. The present study focuses on the identification of potential ligands that can effectively bind with allosteric site of PBP2a, that leads to the access of active site and entry of a β-lactam antibiotic for effective inhibition. The results obtained from our study will be useful for designing effective compounds with potential therapeutic effects against ceftaroline resistant MRSA strains. PMID:26252252

  9. Whole genome sequencing identifies zoonotic transmission of MRSA isolates with the novel mecA homologue mecC

    PubMed Central

    Harrison, Ewan M; Paterson, Gavin K; Holden, Matthew TG; Larsen, Jesper; Stegger, Marc; Larsen, Anders Rhod; Petersen, Andreas; Skov, Robert L; Christensen, Judit Marta; Bak Zeuthen, Anne; Heltberg, Ole; Harris, Simon R; Zadoks, Ruth N; Parkhill, Julian; Peacock, Sharon J; Holmes, Mark A

    2013-01-01

    Several methicillin-resistant Staphylococcus aureus (MRSA) lineages that carry a novel mecA homologue (mecC) have recently been described in livestock and humans. In Denmark, two independent human cases of mecC-MRSA infection have been linked to a livestock reservoir. We investigated the molecular epidemiology of the associated MRSA isolates using whole genome sequencing (WGS). Single nucleotide polymorphisms (SNP) were defined and compared to a reference genome to place the isolates into a phylogenetic context. Phylogenetic analysis revealed two distinct farm-specific clusters comprising isolates from the human case and their own livestock, whereas human and animal isolates from the same farm only differed by a small number of SNPs, which supports the likelihood of zoonotic transmission. Further analyses identified a number of genes and mutations that may be associated with host interaction and virulence. This study demonstrates that mecC-MRSA ST130 isolates are capable of transmission between animals and humans, and underscores the potential of WGS in epidemiological investigations and source tracking of bacterial infections. PMID:23526809

  10. Staphylococcus aureus and MRSA colonization rates among personnel and dogs in a small animal hospital: association with nosocomial infections.

    PubMed

    Walther, Birgit; Wieler, Lothar H; Friedrich, Alexander W; Kohn, Barbara; Brunnberg, Leo; Lübke-Becker, Antina

    2009-01-01

    The genetic relationship of thirty Methicillin-resistant S. aureus (MRSA) isolates derived from the nasal cavities of canine patients hospitalized (n = 7), veterinary personnel (n = 20), and environmental sources (n = 3) sampled during a 20-month investigation period, were analyzed in this study. Genetic relatedness of all MRSA isolates was investigated involving commonly used typing techniques: Pulsed-field gel electrophoresis (PFGE), Multilocus sequence typing (MLST), spa typing, PCR for detection of Panton-Valentine leukocidine (PVL) genes and staphylococcal cassette chromosome mec-typing (SCCmec). Analysis of typing results revealed a certain predominant (72%) genotype: PFGE type IMT-A, ST22, spa type t032, SCCmecIV. This genotype has been reported previously (Walter et al., 2008c) being the predominant PFGE type associated with MRSA-positive clinical specimens, mostly from wound infections, derived from small and exotic animals of that facility. Furthermore, occasionally high rates in nasal colonization of veterinary personnel (18 of 88: 20%) in one of three personal screening periods were accompanied by a sudden rise of MRSA infections in small animals. Our data strongly indicate that high rates of colonized veterinary staff lead to an increase of nosocomial infections in small animal hospitals. We therefore recommend the introduction of surveillance of nosocomial infections especially in surgical veterinary hospitals. PMID:19517931

  11. Antimicrobial activities of bacteriocins E50-52 and B602 against MRSA and other nosocomial infections

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Our objective was to determine the antimicrobial activities of previously published bacteriocins E50-52 and B602 against methicillin resistant Staphylococcus aureus (MRSA) and other prominent nosocomial bacterial infections. methods: Several Russian hospitals were enlisted into the study from 2003 ...

  12. MRSA Carriage in Community Outpatients: A Cross-Sectional Prevalence Study in a High-Density Livestock Farming Area along the Dutch-German Border

    PubMed Central

    Paget, John; Aangenend, Helen; Kühn, Malte; Hautvast, Jeannine; van Oorschot, Desiree; Olde Loohuis, Alphons; van der Velden, Koos; Friedrich, Alexander W.; Voss, Andreas; Köck, Robin

    2015-01-01

    Objectives MRSA poses a considerable public health threat to the community. The objectives of this study were to assess the prevalence of MRSA carriage and determine factors that were associated with MRSA carriage among outpatients who had used antibiotics in the previous three months and who lived in a high-density livestock farming area along the Dutch-German border. Methods Cross-sectional prevalence study carried out between November 2011 and June 2012. Nasal swabs and questionnaires were collected in patients (>4 years) who had used antibiotics in the previous three months from twelve Dutch General Practitioners (GPs), seven German GPs and two German outpatient urologists. To assess nasal carriage, swabs were analyzed using selective MRSA agars after broth enrichment. MRSA positive samples were spa typed. Results Data were collected from 513 GP outpatients in the Netherlands, 261 GP outpatients in Germany and 200 urologist outpatients in Germany. The overall prevalence of MRSA carriage was 0.8%, 1.1% and 2.0%, respectively. In the GP outpatient populations, the prevalence was similar in both countries (0.8% and 1.1%, respectively, p = 0.879), all spa types were indicative for livestock-associated MRSA (4xt011 in the Netherlands; 2xt034 and t011 in Germany) and being a farmer, living on or near (<5km) to a farm were associated with MRSA carriage. In the urologist outpatient population, the prevalence was higher (2.0%), all spa types were indicative for healthcare-associated MRSA (t068, t032, t003, t10231) and being a farmer, living on or near to a farm were factors not associated with MRSA carriage. Conclusions The prevalence of MRSA carriage in these community outpatient populations along the Dutch-German border was low. There were striking similarities in livestock-associated MRSA carriage and clonal spread in the outpatient populations seeing their GP in both countries. In contrast, urologist outpatients in Germany were colonized with spa types indicative of healthcare-associated MRSA. PMID:26619190

  13. Chloramphenicol encapsulated in poly-ε-caprolactone–pluronic composite: nanoparticles for treatment of MRSA-infected burn wounds

    PubMed Central

    Kalita, Sanjeeb; Devi, Banasmita; Kandimalla, Raghuram; Sharma, Kaustav Kalyan; Sharma, Arup; Kalita, Kasturi; Kataki, Amal Chandra; Kotoky, Jibon

    2015-01-01

    The emergence of methicillin-resistant Staphylococcus aureus (MRSA) infection has increased precipitously over the past several decades, with far-reaching health care and societal costs. MRSA infections in the context of burn wounds lead to invasive disease that could potentially cause mortality. Chloramphenicol is a well-known broad-spectrum bacteriostatic antibiotic that has been used since 1949, but due to its hydrophobicity, poor penetration in skin, fast degradation, and toxicity, its application has been hindered. Furthermore, it has been demonstrated that old antibiotics such as chloramphenicol remained active against a large number of currently prevalent resistant bacterial isolates due to their low-level use in the past. Recently, the novel nanoparticulate drug-delivery system has been used and reported to be exceptionally useful for topical therapeutics, due to its distinctive physical characteristics such as a high surface-to-volume ratio and minuscule size. It helps to achieve better hydrophilicity, bioavailability, and controlled delivery with enhanced therapeutic index, which has resulted in decreased toxicity levels compared to the crude drug. Here, we report a novel chloramphenicol loaded with poly(ε-caprolactone) (PCL)-pluronic composite nanoparticles (CAM-PCL-P NPs), physicochemical characterizations, and its bioactivity evaluation in a MRSA-infected burn-wound animal model. CAM-PCL-P NPs could encapsulate 98.3% of the drug in the nanoparticles and release 81% of the encapsulated drug over 36 days with a time to 50% drug release of 72 hours (51%). Nanoparticle suspensions maintained the initial properties with respect to size and encapsulation efficiency, even after 6 months of storage at 4°C and 25°C, respectively (P>0.05). Significant reduction in the level of toxicity was observed for CAM-PCL-P NPs compared with that of free drug as confirmed from hemolytic activity against human blood erythrocytes and cytotoxicity assay against an MCF-7 breast cancer cell line. In vitro antibacterial activities were performed by zone of inhibition, minimum inhibitory concentrations, minimum bacterial concentration, and time-kill assays, which showed that CAM-PCL-P NPs exhibited significantly enhanced anti-MRSA activity against ten clinical isolates of MRSA strains. The augmented activity of CAM-PCL-P NPs was further tested on a MRSA-infected burn-wound animal model and achieved quicker efficacy in MRSA clearance and improved the survival rate compared with free-chloramphenicol treatment. Thus, we propose CAM-PCL-P NPs as a promising novel antimicrobial candidate that may have a good potential for preclinical applications. PMID:25931822

  14. Chloramphenicol encapsulated in poly-?-caprolactone-pluronic composite: nanoparticles for treatment of MRSA-infected burn wounds.

    PubMed

    Kalita, Sanjeeb; Devi, Banasmita; Kandimalla, Raghuram; Sharma, Kaustav Kalyan; Sharma, Arup; Kalita, Kasturi; Kataki, Amal Chandra; Kotoky, Jibon

    2015-01-01

    The emergence of methicillin-resistant Staphylococcus aureus (MRSA) infection has increased precipitously over the past several decades, with far-reaching health care and societal costs. MRSA infections in the context of burn wounds lead to invasive disease that could potentially cause mortality. Chloramphenicol is a well-known broad-spectrum bacteriostatic antibiotic that has been used since 1949, but due to its hydrophobicity, poor penetration in skin, fast degradation, and toxicity, its application has been hindered. Furthermore, it has been demonstrated that old antibiotics such as chloramphenicol remained active against a large number of currently prevalent resistant bacterial isolates due to their low-level use in the past. Recently, the novel nanoparticulate drug-delivery system has been used and reported to be exceptionally useful for topical therapeutics, due to its distinctive physical characteristics such as a high surface-to-volume ratio and minuscule size. It helps to achieve better hydrophilicity, bioavailability, and controlled delivery with enhanced therapeutic index, which has resulted in decreased toxicity levels compared to the crude drug. Here, we report a novel chloramphenicol loaded with poly(?-caprolactone) (PCL)-pluronic composite nanoparticles (CAM-PCL-P NPs), physicochemical characterizations, and its bioactivity evaluation in a MRSA-infected burn-wound animal model. CAM-PCL-P NPs could encapsulate 98.3% of the drug in the nanoparticles and release 81% of the encapsulated drug over 36 days with a time to 50% drug release of 72 hours (51%). Nanoparticle suspensions maintained the initial properties with respect to size and encapsulation efficiency, even after 6 months of storage at 4C and 25C, respectively (P>0.05). Significant reduction in the level of toxicity was observed for CAM-PCL-P NPs compared with that of free drug as confirmed from hemolytic activity against human blood erythrocytes and cytotoxicity assay against an MCF-7 breast cancer cell line. In vitro antibacterial activities were performed by zone of inhibition, minimum inhibitory concentrations, minimum bacterial concentration, and time-kill assays, which showed that CAM-PCL-P NPs exhibited significantly enhanced anti-MRSA activity against ten clinical isolates of MRSA strains. The augmented activity of CAM-PCL-P NPs was further tested on a MRSA-infected burn-wound animal model and achieved quicker efficacy in MRSA clearance and improved the survival rate compared with free-chloramphenicol treatment. Thus, we propose CAM-PCL-P NPs as a promising novel antimicrobial candidate that may have a good potential for preclinical applications. PMID:25931822

  15. The Prevalence, Risk Factors and Changes in Symptoms of Self Reported Asthma, Rhinitis and Eczema Among Pregnant Women in Ogbomoso, Nigeria

    PubMed Central

    Adeyemi, Adewale Samson; Adebayo, Philip Babatunde; Tanimowo, Moses O.; Ayodele, Olugbenga Edward

    2015-01-01

    Background Allergic disorders have become a major public health concern worldwide. No Nigerian study has examined the epidemiology of allergic diseases among women. Aim To document the prevalence, risk factors and the changes in the symptoms of allergic disorders during pregnancy. Settings and Design Cross-sectional study conducted at the booking and antenatal clinics of LAUTECH Teaching Hospital and Millennium Development Goals (MDG) Clinic of the Comprehensive Health Center, Oja Igbo, Ogbomoso, Nigeria. Materials and Methods Study enrolled 432 women from two public hospitals. Sociodemographic and clinical history were obtained and allergic disorders were diagnosed using ISAAC questionnaires. Results The prevalence of wheezing, eczema and rhinitis in pregnancy are 7.5%, 4.0% and 5.8% respectively. The prevalence of wheezing and eczema was slightly higher among the pregnant in past 12 months. Wheeze worsened in 70% (18/26), improved in 15% (2/26), and stable in 15% (2/26). Eczema worsened in 50% (7/14), improved in 7.1% (1/14) and stable in 42.9% (6/14), while allergic rhinitis worsened in 50% (11/22), improved in 22.7% (5/22) and stabilized in 27.3 % (6/22). In multivariate analysis, the risk of allergic diseases in pregnancy was increase 2 times by low income earning (CI: 1.2 – 2.1, p = 0.002), low level education (OR = 0.6, CI: 0.3 – 0.9, p = 0.011) and by family history of asthma, OR-4.3, CI – 1.3 – 13.9, p = 0.015. Family history of asthma increase the chances of asthma by 18.7 times, CI-2.3 – 152.2, p = 0.006, while the odd of eczema was increased 9.1 times (CI-2.7 – 30.6, p<0.001) and 2.4 times (CI: 1.2 – 4.7, p = 0.008) by second hand home smoking and low-family income respectively. The risk of allergic rhinitis were raised 1.8 times by low family income (CI 1.1 – 2.8, p = 0.013) and 3.9 times by family history of rhinitis (OR = 3.9, CI 1.2 – 12.7, p = 0.024). Conclusion Prevalence of wheezing and eczema are higher in pregnancy probably due to exacerbation induced by pregnancy. Social and genetic factors are important risk factors for allergic disorders in pregnancy. PMID:26500933

  16. Noninvasive measuring methods for the investigation of irritant patch test reactions. A study of patients with hand eczema, atopic dermatitis and controls.

    PubMed

    Agner, T

    1992-01-01

    The aim of the study was to assess the susceptibility of clinically normal skin to a standard irritant trauma under varying physiological and patophysiological conditions. Evaluation of skin responses to patch tests with sodium lauryl sulphate (SLS) was used for assessment of skin susceptibility. The following noninvasive measuring methods were used for evaluation of the skin before and after exposure to irritants: measurement of transepidermal water loss by an evaporimeter, measurement of electrical conductance by a hydrometer, measurement of skin blood flow by laser Doppler flowmetry, measurement of skin colour by a colorimeter and measurement of skin thickness by ultrasound A-scan. The studies were carried out on healthy volunteers and patients with eczema. In the first studies the standard irritant patch test for assessment of skin susceptibility was characterized and validated. SLS was chosen among other irritants because of its ability to penetrate and impair the skin barrier. The implications of use of different qualities of SLS was investigated. The applied noninvasive measuring methods were evaluated, and for quantification of SLS-induced skin damage measurement of TEWL was found to be the most sensitive method. Application of the standard test on clinically normal skin under varying physiological and patophysiological conditions lead to the following main results: Seasonal variation in skin susceptibility to SLS was found, with increased susceptibility in winter, when the hydration state of the stratum corneum was also found to be decreased. A variation in skin reactivity to SLS during the menstrual cycle was demonstrated, with an increased skin response at day 1 as compared to days 9-11 in the menstrual cycle. The presence of active eczema distant from the test site increased skin susceptibility to SLS, indicating a generalized hyperreactivity of the skin. Taking these sources of variation into account healthy volunteers and patients with hand eczema and atopic dermatits were studied and compared. In healthy volunteers increased baseline TEWL and increased light reflection from the skin, interpreted as "fair" skin, was found to be associated with increased susceptibility to SLS. Hand eczema patients were found to have fairer and thinner skin than matched controls. Increased susceptibility to SLS was found only in patients with acute eczema. Patients with atopic dermatitis had increased baseline TEWL as well as increased skin susceptibility as compared to controls. Skin susceptibility is thus influenced by individual- as well as environment-related factors. Knowledge of determinants of skin susceptibility may be useful for the identification of high-risk subjects for development of irritant contact dermatitis, and may help to prevent the formation of the disease. PMID:1636360

  17. MRSA-Infected External Iliac Artery Pseudoaneurysm Treated with Endovascular Stenting

    SciTech Connect

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

    2005-04-15

    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 the femoral shaft and right total hip prosthesis disruption. Peripheral arteriography was performed in view of persistent bleeding from the sinus, which revealed a 6 cm false aneurysm filling from and compressing the right external iliac artery (EIA). A PTFE-covered, balloon expandable JOSTENT was deployed in the right EIA, successfully excluding the false aneurysm and preventing further bleeding from the sinus. No graft infection was reported at 12 months. This case illustrates the potential use of endovascular stent-grafting in the treatment of an infected pseudoaneurysm.

  18. Total synthesis and absolute configuration assignment of MRSA active garcinol and isogarcinol.

    PubMed

    Socolsky, Cecilia; Plietker, Bernd

    2015-02-01

    A short total synthesis of (±)-garcinol and (±)-isogarcinol, two endo-type B PPAPs with reported activity against methiciline resistant Staphylococcus aureus (MRSA), is presented. The separation of framework-constructing from framework-decorating steps and the application of two highly regio- and stereoselective Pd-catalysed allylations, that is, the Pd-catalysed decarboxylative Tsuji-Trost allylation and the diastereoselective Pd-catalysed allyl-allyl cross-coupling, are key elements that allowed the total synthesis to be accomplished within 13 steps starting from acetylacetone. After separation of the enantiomers the absolute configurations of the four natural products (i.e., (-)-garcinol, (+)-guttiferone E (i.e., ent-garcinol), (-)-isogarcinol, and (+)-isoxanthochymol (i.e., ent-isogarcinol)) were assigned based on ECD spectroscopy. PMID:25537962

  19. Telavancin for the treatment of nosocomial pneumonia caused by methicillin-resistant Staphylococcus aureus (MRSA)

    PubMed Central

    Hooper, Candace Y; Smith, Winter J

    2012-01-01

    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. PMID:22547931

  20. How Often Do Comparative Randomised Controlled Trials in the Field of Eczema Fail to Directly Compare the Treatments Being Tested?

    PubMed Central

    Ratib, Sonia; Wilkes, Sally R.; Nankervis, Helen; Thomas, Kim S.; Williams, Hywel C.

    2015-01-01

    The objective of the study was to identify all parallel design randomised controlled trials (RCTs) comparing treatments for eczema in recent dermatology literature that have failed to report a between-group analysis. The GREAT database (www.greatdatabase.org.uk) was searched to identify parallel group RCTs comparing two or more interventions published in the English language in the last decade, 2004 to 2013. The primary outcome was the number of studies that had not reported a between-group analysis for any of the outcomes. Where possible we re-analysed the data to determine whether a between-group analysis would have given a different conclusion to that reported. Out of a total of 304 RCTs in the study period, 173 (56.9%) met the inclusion criteria. Of the 173 eligible studies, 12 (6.9%) had not conducted a between-group analysis for any of the reported outcomes. There was no clear improvement over time. Five of the eight studies that were re-analysed yielded non-significant between-group differences yet reported significant within-group comparisons. All but one of the 12 studies implied that the experimental intervention was successful despite not undertaking any between-group comparisons. Although the proportion of all RCTs that fail to report an appropriate between-group analysis is small, the fact that any scientist who purports to compare one treatment against another then chooses to omit the key comparison statistic is worrying. PMID:26239561

  1. Birch pollen influence the severity of atopic eczema – prospective clinical cohort pilot study and ex vivo penetration study

    PubMed Central

    Fölster-Holst, Regina; Galecka, Jagoda; Weißmantel, Sigo; Dickschat, Ute; Rippke, Frank; Bohnsack, Kerstin; Werfel, Thomas; Wichmann, Katja; Buchner, Matthias; Schwarz, Thomas; Vogt, Annika; Lademann, Jürgen; Meinke, Martina C

    2015-01-01

    There is little clinical evidence for a correlation between the severity of atopic eczema (AE) and pollen exposition. To obtain more data, we performed a clinical cohort pilot study about the influence of pollen on AE between sensitized and nonsensitized subjects and an experimental study addressing the cutaneous penetration of pollen into the skin. Fifty-five patients were monitored during birch pollen season. To study the cutaneous penetration, grass pollen allergens were applied on excised skin and the uptake in CD1c-expressing dendritic cells was investigated. The correlation between environmental pollen load and severity of the Scoring Atopic Dermatitis (SCORAD) score and pruritus was observed, regardless of the status of sensitization. The sensitized group recovered significantly worse after the birch pollen season. Remarkably higher amounts of pollen allergens taken up by CD1c cells were detected in epidermal cells derived from skin explants with a disturbed epidermal barrier. These findings suggest an exacerbating role of pollen in AE utilizing the epidermal route. PMID:26604810

  2. What's new in atopic eczema? An analysis of systematic reviews published in 2012 and 2013. Part 2. Treatment and prevention.

    PubMed

    Madhok, V; Futamura, M; Thomas, K S; Barbarot, S

    2015-06-01

    This review provides a summary of key findings from 22 systematic reviews on atopic eczema (AE) published over the 2-year period from January 2012 to 31 December 2013, focusing on prevention and treatment of AE. For an update of systematic reviews on the epidemiology, mechanisms of disease and methodological issues, see Part 1 of this update. Based on current systematic review evidence, the most promising intervention for the prevention of AE is the use of probiotics (and possibly prebiotics) during the late stages of pregnancy and early life. Exposure to household pets, especially dogs, may also be protective, but exclusive breastfeeding for up to 7 months does not confer benefit. The role of vitamin D in preventing AE is currently unclear. Very few of the systematic reviews provided additional evidence for the use of specific treatments for AE. Further research is required to establish the role of desensitization, Chinese herbal medicines, homeopathy and specialist clothing. Nevertheless, there is now clear evidence that evening primrose oil and borage oil are not effective for the treatment of AE. There have been no randomized controlled trials on the use of H1 anti-histamines as monotherapy for the treatment of AE. PMID:25622761

  3. Climate and prevalence of atopic eczema in 6- to 7-year-old school children in Spain. ISAAC phase III.

    PubMed

    Suárez-Varela, María Morales; García-Marcos Alvarez, Luís; Kogan, Michael D; González, Agustín Llopis; Gimeno, Antonio Martínez; Aguinaga Ontoso, Inés; Díaz, Carlos González; Pena, Alberto Arnedo; Aurrecoechea, Begoña Domínguez; Monge, Rosa María Busquets; Quiros, Alfredo Blanco; Garrido, José Batlles; Canflanca, Iñaqui Miner; Varela, Angel López-Silvarrey

    2008-11-01

    Atopic eczema (AE) is a chronic skin disease. Recent reports indicate that the worldwide prevalence of AE is increasing and that various environmental factors are implicated in its aetiology. Climatic conditions have been related with AE prevalence, and Spain has varying climatic conditions. The aim of this study is to document the possible climatic influence on the prevalence of AE in schoolchildren aged 6-7 years in three different climatic regions in Spain. We conducted a cross-sectional population-based survey of 28,394 schoolchildren aged 6-7 years from 10 Spanish centres in three different climatic regions. The mean participation rate was 76.5%. AE prevalence was assessed using the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire and the Spanish Academy of Dermatology criteria used in Spain to diagnose AE. The data, including annual temperature, precipitation, relative humidity and the annual number of sunny hours per climatic region, were obtained from the Spanish National Institute of Meteorology. Different AE prevalences were found in all three climatic regions studied: Atlantic, 32.9; Mediterranean 28.3; and Continental 31.2 per 100 children studied (p < 0.005). AE was positively associated with precipitation and humidity, and was negatively associated with temperature and the number of sunny hours. The results show that AE is significantly dependent on meteorological conditions. PMID:18779981

  4. The degree of virulence does not necessarily affect MRSA biofilm strength and response to photodynamic therapy.

    PubMed

    Abouelfetouh, Alaa A Y; Nafee, Noha A; Moussa, Nihal K

    2016-02-01

    Biofilm formation transforms infections from acute to chronic, increasing patient mortality and significantly increasing healthcare costs. We are studying the prevalence of some virulence genes among methicillin resistant Staphylococcus aureus (MRSA) isolates relative to biofilm formation and the potential of photoactivated hypericin to treat these infections. Isolates were collected from three Egyptian governorates over seven months in 2011, 100 isolates were identified as MRSA. Biofilm formation was established using crystal violet staining and 2,3,5-triphenyl tetrazolium chloride reduction. Twenty two percent of the isolates formed biofilms, of which 68.2% were moderate to strong. The virulence genes were detected using polymerase chain reaction. spaX (x-region of protein A) was most prevalent. All biofilm-formers lacked cap5 (capsular polysaccharide 5), the other genes were: nuc (thermonuclease) > clfA (clumping factor) > spaIgG (IgG binding site of protein A), fnbA (fibronectin protein A), cap8 (capsular polysaccharide 8), agr (accessory-gene-regulator locus) > fnbB (fibronectin protein B). agr-locus was only found in 22.22% of moderate biofilm-formers, the remaining genes were almost equally prevalent among biofilm-formers and negative controls. Photoactivated hypericin efficiently inhibited 92.2-99.9% of biofilm viability, irrespective of the number of virulence genes. To conclude, biofilm formation, and treatment might be affected by a myriad of virulence factors rather than a single gene, however, photoactivated hypericin remains a potential antibiofilm approach. PMID:26616167

  5. Supporting Self-Care for Families of Children With Eczema With a Web-Based Intervention Plus Health Care Professional Support: Pilot Randomized Controlled Trial

    PubMed Central

    Muller, Ingrid; Yardley, Lucy; Burgess, Hana; Selinger, Hannah; Stuart, Beth L; Little, Paul

    2014-01-01

    Background Childhood eczema, or childhood atopic dermatitis, causes significant distress to children and their families through sleep disturbance and itch. The main cause of treatment failure is nonuse of prescribed treatments. Objective The objective of this study was to develop and test a Web-based intervention to support families of children with eczema, and to explore whether support from a health care professional (HCP) is necessary to engage participants with the intervention. Methods We followed the PRECEDE-PROCEED model: regular emollient use was the target behavior we were seeking to promote and we identified potential techniques to influence this. LifeGuide software was used to write the intervention website. Carers of children with eczema were invited through primary care mail-out and randomized to 3 groups: (1) website only, (2) website plus HCP support, or (3) usual care. Patient-Oriented Eczema Measure (POEM) scores were measured online by carer report at baseline and at 12 weeks. Qualitative interviews were carried out with 13 HCPs (primarily practice nurses) and 26 participants to explore their experiences of taking part in the study. Results A total of 143 carers were recruited through 31 practices. We found a decrease of ≥2 in follow-up compared with baseline POEM score in 23 of 42 (55%) participants in the website only group, 16 of 49 (33%) in the usual care group, and 18 of 47 (38%) in the website plus HCP group. Website use data showed that 75 of 93 (81%) participants allocated to the website groups completed the core modules, but less than half used other key components (videos: 35%; regular text reminders: 39%). There were no consistent differences in website use between the website only or the website plus HCP groups. Qualitative feedback showed that most HCPs had initial concerns about providing support for eczema self-care because this was not a condition that they felt expert in. However, HCPs reported productive consultations and that they found it helpful to use the website in consultations, while observing that some participants seemed to need more support than others. Qualitative interviews with participants suggested that HCP support was valued highly only by a minority, generally those who were less confident in their management of eczema or less confident using the Internet. Conclusions Our pilot trial demonstrated the potential for greater improvements in POEM scores in both website intervention groups and that a full-scale trial is feasible. Such a trial would quantify the effectiveness and cost-effectiveness of this intervention to determine whether it should be widely promoted to families of children with newly diagnosed eczema. In this study population, HCP support was not strongly valued by participants and did not lead to better outcomes or website use than use of the Web-based intervention alone. Trial Registration International Standard Randomized Controlled Trial Number (ISRCTN): 98560867; http://www.controlled-trials.com/ISRCTN98560867 (Archived by WebCite at http://www.webcitation.org/6NcxvMtgN). PMID:24594972

  6. 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

    Shore, Anna C.; Corcoran, Suzanne; Tecklenborg, Sarah; Coleman, David C.; O'Connell, Brian

    2012-01-01

    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. PMID:22189119

  7. Isolation of Methicillin-Resistant Staphylococcus aureus (MRSA) from HIV Patients Referring to HIV Referral Center, Shiraz, Iran, 2011-2012.

    PubMed

    Hassanzadeh, Parvin; Hassanzadeh, Yashgin; Mardaneh, Jalal; Rezai, Esmaeel; Motamedifar, Mohammad

    2015-11-01

    Extension of drug resistant Staphylococcus aureus strains is one of the problems of modern society. Presence of methicillin-resistant Staphylococcus aureus (MRSA) in HIV-infected individuals is an important cause of severe infections. Therefore, the main goal of this study was to determine the prevalence rate of MRSA carriage rate among HIV patients referring to the Shiraz HIV referral center (Shiraz, Iran) during 2011-2012. Nasal swabs were obtained from HIV positive patients and were cultured on differential and selective media to isolate Staphylococcus aureus, which was confirmed by standard biochemical tests. For isolation of MRSA isolates, bacterial suspensions were cultured on Muller-Hinton Agar containing NaCl and Oxacillin. Finally, data were analyzed by the SPSS software. Of 180 HIV patients, MRSA was isolated from nasal cavity of 23 (12.8%) patients. Most of the isolates were recovered from male subjects who were under 40 years old. No variables such as skin disease, history of hospitalization or infectious disease had significant association with the MRSA colonization rate. The presence of MRSA isolates in the nasal cavity of HIV patients in such a rate warns us about the potential spreading of MRSA among HIV patients in our society and emphasizes on establishing better prevention strategies. PMID:26538782

  8. Antibacterial Evaluation of Synthetic Thiazole Compounds In Vitro and In Vivo in a Methicillin-Resistant Staphylococcus aureus (MRSA) Skin Infection Mouse Model

    PubMed Central

    Mohammad, Haroon; Cushman, Mark; Seleem, Mohamed N.

    2015-01-01

    The emergence of community-associated methicillin-resistant Staphylococcus aureus (MRSA), including strains resistant to current antibiotics, has contributed to an increase in the number of skin infections reported in humans in recent years. New therapeutic options are needed to counter this public health challenge. The aim of the present study was to examine the potential of thiazole compounds synthesized by our research group to be used topically to treat MRSA skin and wound infections. The broth microdilution method confirmed that the lead thiazole compound and four analogues are capable of inhibiting MRSA growth at concentrations as low as 1.3 μg/mL. Additionally, three compounds exhibited a synergistic relationship when combined with the topical antibiotic mupirocin against MRSA in vitro via the checkerboard assay. Thus the thiazole compounds have potential to be used alone or in combination with mupirocin against MRSA. When tested against human keratinocytes, four derivatives of the lead compound demonstrated an improved toxicity profile (were found to be non-toxic up to a concentration of 20 μg/mL). Utilizing a murine skin infection model, we confirmed that the lead compound and three analogues exhibited potent antimicrobial activity in vivo, with similar capability as the antibiotic mupirocin, as they reduced the burden of MRSA present in skin wounds by more than 90%. Taken altogether, the present study provides important evidence that these thiazole compounds warrant further investigation for development as novel topical antimicrobials to treat MRSA skin infections. PMID:26536129

  9. Artesunate has its enhancement on antibacterial activity of β-lactams via increasing the antibiotic accumulation within methicillin-resistant Staphylococcus aureus (MRSA).

    PubMed

    Jiang, Weiwei; Li, Bin; Zheng, Xinchuan; Liu, Xin; Pan, Xichun; Qing, Rongxin; Cen, Yanyan; Zheng, Jiang; Zhou, Hong

    2013-06-01

    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 β-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 β-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

  10. Incidence and Characterisation of Methicillin-Resistant Staphylococcus aureus (MRSA) from Nasal Colonisation in Participants Attending a Cattle Veterinary Conference in the UK

    PubMed Central

    Paterson, Gavin K.; Harrison, Ewan M.; Craven, Emily F.; Petersen, Andreas; Larsen, Anders Rhod; Ellington, Matthew J.; Török, M. Estée; Peacock, Sharon J.; Parkhill, Julian; Zadoks, Ruth N.; Holmes, Mark A.

    2013-01-01

    We sought to determine the prevalence of nasal colonisation with methicillin-resistant Staphylococcus aureus among cattle veterinarians in the UK. There was particular interest in examining the frequency of colonisation with MRSA harbouring mecC, as strains with this mecA homologue were originally identified in bovine milk and may represent a zoonotic risk to those in contact with dairy livestock. Three hundred and seven delegates at the British Cattle Veterinarian Association (BCVA) Congress 2011 in Southport, UK were screening for nasal colonisation with MRSA. Isolates were characterised by whole genome sequencing and antimicrobial susceptibility testing. Eight out of three hundred and seven delegates (2.6%) were positive for nasal colonisation with MRSA. All strains were positive for mecA and none possessed mecC. The time since a delegate’s last visit to a farm was significantly shorter in the MRSA-positive group than in MRSA-negative counterparts. BCVA delegates have an increased risk of MRSA colonisation compared to the general population but their frequency of colonisation is lower than that reported from other types of veterinarian conference, and from that seen in human healthcare workers. The results indicate that recent visitation to a farm is a risk factor for MRSA colonisation and that mecC-MRSA are rare among BCVA delegates (<1% based on sample size). Contact with livestock, including dairy cattle, may still be a risk factor for human colonisation with mecC-MRSA but occurs at a rate below the lower limit of detection available in this study. PMID:23869220

  11. Can MLVA Differentiate among Endemic-Like MRSA Isolates with Identical Spa-Type in a Low-Prevalence Region?

    PubMed Central

    Blomfeldt, Anita; Hasan, Abdullahi Abdi; Aamot, Hege Vangstein

    2016-01-01

    The prevalence of methicillin-resistant Staphylococcus aureus (MRSA) in Norway is low, but an endemic-like MRSA clone with Staphylococcal protein A (spa)-type t304 has been established especially in nursing homes in the Oslo region causing several large outbreaks. The challenge was that spa-typing and the gold standard Pulsed-Field Gel Electrophoresis (PFGE) were inadequate in discriminating isolates in outbreak investigations. Additional higher resolution genotyping methods were needed. The aims of this study were a) to evaluate whether Multiple-Locus Variable number of tandem repeat Analysis (MLVA) could differentiate within the PFGE clusters between epidemiologically related and unrelated endemic-like ST8-MRSA-IV-t304-PVL-neg (MRSA-t304) isolates and b) investigate the evolution of the endemic-like MRSA-t304 clone over a 15-year time period. All MRSA-t304 isolates detected in the region from 1998 through April 2013 were included. In total, 194 of 197 isolates were available for PFGE and MLVA analyses. PFGE results on isolates from 1998–2010 have been published previously. Two PFGE clusters subdivided into eight MLVA types were detected. One major outbreak clone (PFGE cluster C2/ MLVA type MT5045) appeared from 2004 to 2011 causing long-lasting and large outbreaks in seven nursing homes and one hospital. Five new MLVA types (N = 9 isolates) differing in only one VNTR compared to the outbreak clone C2/MT5045 were detected, but only one (C2/MT5044) was seen after 2011. We suggest that MLVA can replace PFGE analysis, but MLVA may not be the optimal method in this setting as it did not discriminate between all epidemiologically unrelated isolates. The results may indicate that all eight outbreaks in different locations within the PFGE C2 cluster may be branches of one large regional outbreak. The major outbreak strain C2/MT5045 may now, however, be under control, extinguished or has moved geographically. PMID:26859765

  12. Effects of air pollution on lung function and symptoms of asthma, rhinitis and eczema in primary school children.

    PubMed

    Altuğ, Hicran; Gaga, Eftade O; Döğeroğlu, Tuncay; Ozden, Ozlem; Ornektekin, Sermin; Brunekreef, Bert; Meliefste, Kees; Hoek, Gerard; Van Doorn, Wim

    2013-09-01

    Health effects of ambient air pollution were studied in three groups of schoolchildren living in areas (suburban, urban and urban-traffic) with different air pollution levels in Eskişehir, Turkey. This study involved 1,880 students aged between 9 and 13 years from 16 public primary schools. This two-season study was conducted from January 2008 through March 2009. Symptoms of asthma, rhinitis and eczema were determined by the International Study of Asthma and Allergies in Childhood questionnaire in 2008. Two lung function tests were performed by each child for summer and winter seasons with simultaneous ambient air measurements of ozone (O3), nitrogen dioxide (NO2) and sulfur dioxide (SO2) by passive sampling. Effects of air pollution on impaired lung function and symptoms in schoolchildren were estimated by multivariate logistic regression analyses. Girls with impaired lung function (only for the summer season evaluation) were more observed in suburban and urban areas when compared to urban-traffic area ([odds ratio (OR) = 1.49; 95 % confidence interval (CI) 1.04-2.14] and [OR = 1.69 (95 % CI 1.06-2.71)] for suburban vs. urban-traffic and urban vs. urban-traffic, respectively). Significant association between ambient ozone concentrations and impaired lung function (for an increase of 10 μg m(-3)) was found only for girls for the summer season evaluation [OR = 1.11 (95 % CI 1.03-1.19)]. No association was found for boys and for the winter season evaluation. No association was found between any of the measured air pollutants and symptoms of current wheeze, current rhinoconjunctivitis and current itchy rash. The results of this study showed that increasing ozone concentrations may cause a sub-acute impairment in lung function of school aged children. PMID:23591930

  13. Antibacterial activity of stilbene oligomers against vancomycin-resistant Enterococci (VRE) and methicillin-resistant Staphylococcus aureus (MRSA) and their synergism with antibiotics.

    PubMed

    Sakagami, Yoshikazu; Sawabe, Akiyoshi; Komemushi, Sadao; All, Zulfiqar; Tanaka, Toshiyuki; Iliya, Ibrahim; Iinuma, Munekazu

    2007-03-01

    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

  14. An outbreak of post-partum breast abscesses in Mumbai, India caused by ST22-MRSA-IV: genetic characteristics and epidemiological implications.

    PubMed

    Manoharan, A; Zhang, L; Poojary, A; Bhandarkar, L; Koppikar, G; Robinson, D A

    2012-10-01

    A cluster of methicillin-resistant Staphylococcus aureus (MRSA) breast abscesses in women who had given birth at a hospital in Mumbai, India was investigated retrospectively. Nineteen of 20 cases were caused by a single clone: pvl-positive, spa type 648 (Ridom t852), ccrB:dru subtype 3:0, ST22-MRSA-IV. Despite the presence of pvl and SCCmec type IV, which are common genetic markers in community-associated MRSA, this outbreak was caused by a healthcare-associated, community-onset MRSA that was common in the hospital environment. Thus, infection control practices may have an important role in limiting the spread of this virulent clone. PMID:22475374

  15. Aryl-Alkyl-Lysines: Agents That Kill Planktonic Cells, Persister Cells, Biofilms of MRSA and Protect Mice from Skin-Infection.

    PubMed

    Ghosh, Chandradhish; Manjunath, Goutham B; Konai, Mohini M; Uppu, Divakara S S M; Hoque, Jiaul; Paramanandham, Krishnamoorthy; Shome, Bibek R; Haldar, Jayanta

    2015-01-01

    Development of synthetic strategies to combat Staphylococcal infections, especially those caused by methicillin resistant Staphyloccus aureus (MRSA), needs immediate attention. In this manuscript we report the ability of aryl-alkyl-lysines, simple membrane active small molecules, to treat infections caused by planktonic cells, persister cells and biofilms of MRSA. A representative compound, NCK-10, did not induce development of resistance in planktonic cells in multiple passages and retained activity in varying environments of pH and salinity. At low concentrations the compound was able to depolarize and permeabilize the membranes of S. aureus persister cells rapidly. Treatment with the compound not only eradicated pre-formed MRSA biofilms, but also brought down viable counts in bacterial biofilms. In a murine model of MRSA skin infection, the compound was more effective than fusidic acid in bringing down the bacterial burden. Overall, this class of molecules bears potential as antibacterial agents against skin-infections. PMID:26669634

  16. Aryl-Alkyl-Lysines: Agents That Kill Planktonic Cells, Persister Cells, Biofilms of MRSA and Protect Mice from Skin-Infection

    PubMed Central

    Ghosh, Chandradhish; Manjunath, Goutham B.; Konai, Mohini M.; Uppu, Divakara S. S. M.; Hoque, Jiaul; Paramanandham, Krishnamoorthy; Shome, Bibek R.; Haldar, Jayanta

    2015-01-01

    Development of synthetic strategies to combat Staphylococcal infections, especially those caused by methicillin resistant Staphyloccus aureus (MRSA), needs immediate attention. In this manuscript we report the ability of aryl-alkyl-lysines, simple membrane active small molecules, to treat infections caused by planktonic cells, persister cells and biofilms of MRSA. A representative compound, NCK-10, did not induce development of resistance in planktonic cells in multiple passages and retained activity in varying environments of pH and salinity. At low concentrations the compound was able to depolarize and permeabilize the membranes of S. aureus persister cells rapidly. Treatment with the compound not only eradicated pre-formed MRSA biofilms, but also brought down viable counts in bacterial biofilms. In a murine model of MRSA skin infection, the compound was more effective than fusidic acid in bringing down the bacterial burden. Overall, this class of molecules bears potential as antibacterial agents against skin-infections. PMID:26669634

  17. Mediterranean diet adherence during pregnancy and risk of wheeze and eczema in the first year of life: INMA (Spain) and RHEA (Greece) mother-child cohort studies.

    PubMed

    Chatzi, Leda; Garcia, Raquel; Roumeliotaki, Theano; Basterrechea, Mikel; Begiristain, Haizea; Iñiguez, Carmen; Vioque, Jesus; Kogevinas, Manolis; Sunyer, Jordi

    2013-12-14

    Maternal diet during pregnancy might influence the development of childhood allergic disorders. The aim of the present study was to evaluate the impact of Mediterranean diet (MD) adherence during pregnancy on wheeze and eczema in the first year of life in two population-based mother-child cohorts in Spain and Greece. We studied 1771 mother-newborn pairs from the Spanish multi-centre 'INMA' (INfancia y Medio Ambiente) study (Gipuzkoa, Sabadell and Valencia) and 745 pairs from the 'RHEA' study in Crete, Greece. The symptoms of wheeze and eczema were based on the criteria of the International Study of Asthma and Allergies in Childhood. Maternal diet during pregnancy was assessed by FFQ and MD adherence was evaluated through an a priori score. Multivariate log-binomial regression models were used to adjust for several confounders in each cohort and summary estimates were obtained by a meta-analysis. MD adherence was not associated with the risk of wheeze and eczema in any cohort, and similar results were identified in the meta-analysis approach. High meat intake (relative risk (RR) 1·22, 95 % CI 1·00, 1·49) and 'processed' meat intake (RR 1·18, 95 % CI 1·02, 1·37) during pregnancy were associated with an increased risk of wheeze in the first year of life, while a high intake of dairy products was significantly associated with a decreased risk of infantile wheeze (RR 0·83, 95 % CI 0·72, 0·96). The results of the present study show that high meat intake during pregnancy may increase the risk of wheeze in the first year of life, while a high intake of dairy products may decrease it. PMID:23680284

  18. Evaluation of the nasal microbiota in slaughter-age pigs and the impact on nasal methicillin-resistant Staphylococcus aureus (MRSA) carriage

    PubMed Central

    2014-01-01

    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 2133736, 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. PMID:24628871

  19. [Effect of MRSA on treatment and care in Finland - applications for compensation and complaints in 1993 to 2012].

    PubMed

    Lumio, Jukka

    2015-01-01

    Events involving applications for compensation or filing a complaint in a MRSA case in Finland by patients or family members were studied for over a twenty-year period. The number of cases found was 305. Of the applications, only 7% resulted in compensation, and none of the complaints led to a change in decision. The discontentment was more commonly associated with the possible MRSA-induced impairment of the given treatment or limitations in freedom than with the fear of the direct health effects of the infection. In order to avoid problems, essential aspects include an intimate knowledge of guidelines among those working in the treatment and care sector, and proper informing of the patients about the effects of MRA on life. PMID:26536722

  20. Effects of Reducing Antimicrobial Use and Applying a Cleaning and Disinfection Program in Veal Calf Farming: Experiences from an Intervention Study to Control Livestock-Associated MRSA.

    PubMed

    Dorado-García, Alejandro; Graveland, Haitske; Bos, Marian E H; Verstappen, Koen M; Van Cleef, Brigitte A G L; Kluytmans, Jan A J W; Wagenaar, Jaap A; Heederik, Dick J J

    2015-01-01

    With the ultimate aim of containing the emergence of resistant bacteria, a Dutch policy was set in place in 2010 promoting a reduction of antimicrobial use (AMU) in food-producing animals. In this context, a study evaluated strategies to curb livestock-associated methicillin resistant Staphylococcus aureus (LA-MRSA). Fifty-one veal calf farms were assigned to one of 3 study arms: RAB farms reducing antimicrobials by protocol; RAB-CD farms reducing antimicrobials by protocol and applying a cleaning and disinfection program; and Control farms without interventions. MRSA carriage was tested in week 0 and week 12 of 2 consecutive production cycles in farmers, family members and veal calves. Interventions were validated and a cyclic rise in MRSA-prevalence in animals was shown with a more moderate increase in RAB farms. Prevalence in humans declined parallel over time in the study arms but RAB farms were at the lowest MRSA levels from the beginning of the study. In RAB-CD farms, human and animal prevalence did not differ from Control farms and MRSA air loads were significantly higher than in the other study