Characterization of Staphylococcus aureus Isolated from Clinical Specimens by Matrix Assisted Laser Desorption/Ionization Time-of-flight Mass Spectrometry

Objective To develop a matrix assisted laser desorption/ionization time-of-flight mass spectrometry （MALDI-TOF-MS） approach to identify Staphylococcus aureus （5. aureus） and differentiate methicillin-resistant 5. aureus （MRSA） from methicillin-sensitive S. aureus （MSSA）. Methods A total of 100 5. aureus strains isolated from clinical specimens and farm workers were collected and analyzed by MALDI-TOF-MS. And data obtained were interpreted with biotyper software. Results Ninety-two strains were identified by MALDI-TOF-MS as 5. aureus at a level of secure genus and probable species, and 4 strains were identified at probable genus after their cultivation, spectral collection and data preprocessing. One strain was identified as 5. aureus with lower score. It was revealed that identification of 5. aureus by MALDI-TOF-MS was highly correlated with typing by biochemical and serological methods with an accuracy as high as 97%. The biotyper cluster analysis showed that 100 isolates were divided into 2 types at the distance level of 400. Higher peak intensity in the mass of both 3784 Da and 5700 Da was observed in MRSA, whereas that was absent from MSSA. Conclusion MALDI-TOF-MS is considered as a simple, high-throughput and accuracy for the identification of S from MSSA. rapid and highly reproducible technique with aureus and it can reliably differentiate MRSA

Determining of antibiotic resistance profile in Staphylococcus aureus isolates

Objective:To determine the pattern of antibiotic resistance among Staphylococcus aureus(S. aureus) isolates from clinical specimens and to identify community-acquired methicillin-resistant Staphylococcus aureus(CA-MRSA) in specimens that have been collected from patients referring to one of the hospitals of Ahvaz.Methods:S.aureus isolates from a hospital in Ahvaz were screened for resistance to various antibiotics including methicillin.The susceptibility of the isolates was determined by Kirby-Bauer disc diffusion method.The MRSA was also treated with ethidium bromide to find the origin of resistance.Results:Among the bacterial isolates,all of 11 S.aureus were resistant to methicillin and cefixime,2 were resistant to ciprofloxacin,6 were resistant to tetracycline and the reminder were sensitive or intermediate to other antibiotics.The treated isolates were reminded resistant to methicillin and this suggested that the plasmid was not the origin of resistance in these isolates.Conclusions:These results showed that infection due to MRSA is widespread in Ahvaz and with respect to the spread of vancomycin resistance among MRSA and appearance of overwhelming infections.It is necessary to identify continuously the profile of antibiotic resistance among S.aureus isolates in other regions and finding appropriate antibiotic for infection control and eradication.

A report on infection dynamics of inducible clindamycin resistance of Staphylococcus aureus isolated from a teaching hospital in India

Objective:To investigate the infection of hospital-and community-acquired"erythromycininduced clindamycin resistant"strains or D-test positives of clinical isolates of Staphylococcus aureus(S.aureus)(with and without methicillin resistance)in a hospital.Methods:Strains of S.aureus isolated from clinical specimens were subjected to D-test and antibiotic profiling.Results:Of the total 278 isolates,140(50.35%)were D-test positives and the rest were D-test negatives.Further,of 140(100%)pesitives,87(62.14%)and 53(37.85%)strains were from males and females,respectively.Of 140(100%)pesitives,117(83.57%)were methicillin resistant S.aureus and23(16.42%)were methicillin sensitive S.aureus;of 140 strains,103(73.57%)strains front persons with and 37(26.42%)were without related infections;of 140 strains,91(65%)and 49(35%)were from hospital-and community-acquired samples,respectively.In 140 strains,118(84.28%)with comorbidities and 22(15.71%)without comorbidities cases were recorded;similarly,persons with prior antibiotic uses contributed 108(77.14%)and without 32(22.85%)positive strains.These binary data of surveillance were analyzed by a univariate analysis.It was evident that the prior antibiotic uses and comorbidities due to other ailments were the determinative factors in D-test positivity,corroborated by low P values,P=0.001 1 and 0.0024,respectively.All isolates(278)were resistant to17 antibiotics of nine groups,in varying degrees;the minimum of 28%resistance for vancomycin and the maximum of 97%resistance for gentamicin were recorded.Further,of 278 strains,only42(15.1%)strains were resistant constitutively to both antibiotics,erythromycin resistant and clindamycin resistant,while 45(16.2%)strains were constitutively sensitive to both antibiotics(erythromycin sensitive,and clindamycin sensitive).Further,of the rest 191(68.7%)strains were with erythromycin resistant and clindamycin resistant,of which only 140(50.35%)strains were D-test positives,while the rest 51(18.34%)strains were D-test negatives.Conclusions:In view of high prevalence of D-test positive S.aureus strains,and equally high prevalence of multidrug resistant strains both in community and hospital sectors,undertaking of D-test may be routinely conducted for suppurative infections.

Molecular typing of methicillin and vancomycin-resistant Staphylococcus aureus isolated from clinical specimens by double locus sequence typing(DLST)method

Methicillin-resistant Staphylococcus aureus(MRSA)strains are the essential cause of infections in communities and hospitals.The present study was conducted to determine the molecular typing of MRSA,isolated from hospitalized patients,using the double-locus sequence typing(DLST).In total,280 S.aureus isolated from clinical specimens by phenotypic(catalase,coagulase,DNase,oxacillin,vancomycin screening agar and antibiotic disk diffusion),and molecular methods(PCR for determining the mecA,vanA and nuc genes).The DLST and sequencing was performed for MRSA containing mecA.Out of 280 specimens,confirmed as Staphylococcus aureus(S.aureus),123(43.9%)strains were MRSA.The highest resistance toward the erythromycin(15μg),followed by ciprofloxacin(5μg),clindamycin(2μg),tetracycline(30μg),gentamicin(10μg)and rifampicin(5μg),was 98.3%,97.5%,94.3%,90.2%,83.7%and 41.4%,respectively.Also,the least resistance(0%)was observed in each of teicoplanin(30μg),linzolide(30μg),and vancomycin(30μg).All(100%)of MRSA strains had the mecA,and none of them have had the vanA.The results of DLST showed that the most common sequence types were BPH 2003 and 0217.The DLST type 18-32 was a significant cluster of MRSA.By sequencing MRSA and comparing the dominant types via the DLST,it is possible to establish the etiology of the disease in a much shorter time,and prevent the complications of the disease.Therefore,the combination of partial sequences of clfB and spa can serve as useful genetic markers for MRSA typing.It concluded that the MRSA in our region was relatively high,but no vancomycin resistance was found.The majority of the MRSA DLST type was 18–32.

Antimicrobial Susceptibility Patterns of Staphylococcus aureus Strains Isolated at the Namibia Institute of Pathology from 2012 to 2014

Staphylococcus aureus (S. aureus) is known to acquire resistance to new drugs and continues to defy at-tempts to control it. Infections caused by antibiotic resistant strains of S. aureus have reached epidemic proportions globally and the increasing rates of antimicrobial resistance are resulting in fewer treatment options. Methicillin resistant S. aureus (MRSA) has also emerged as a serious therapeutic problem worldwide. However, data on the antimicrobial susceptibility patterns of this bacterium over a period of time in Namibia are not available. A descriptive retrospective study was therefore conducted to investigate the antimicrobial susceptibility patterns of 600 Staphylococcus aureus strains isolated at the Namibia Institute of Pathology (NIP) from January 2012 to December 2014. The results showed that a high proportion of isolates were resistant to penicillin (92.4%) and cotrimoxazole (44.9%), while the antibiotics to which the isolates were least resistant included vancomycin (0%), fusidic acid (0.3%) and ciprofloxacin (4.4%). Methicillin resistance was observed in 13.5% of the staphylococcal isolates. Apart from clindamycin (P value = 0.039) and cotrimoxazole (P value = 0.030), the susceptibility patterns of the antibiotics did not differ significantly over the three years. Moreover, wound swabs and sputum were the clinical samples from which S. aureus was most commonly isolated at NIP. The results from this study suggest that continuous local surveillance on the resistance patterns of S. aureus should be performed on regular basis in Namibia, in order to have adequate information for the empirical treatment of S. aureus infections.

Emergence of vancomycin-intermediate resistant Staphylococcus aureus in north of Palestine

Objective:This study was conducted to update the prevalence of methicillin-resistant Staphylococcus aureus(MRSA) isolates among human clinical S.aureus isolates recovered from Northern Palestine,to evaluate the possible presence of vancomycin-Resistant S.aureus(VRSA) and vancomycin- intermediate resistant S.aureus strains(VISA) and to determine the antimicrobial susceptibilities of these clinical isolates.Methods:The in vitro activities of 11 antibiotics against 204 non-duplicate S.aureus isolates from clinical samples in North of Palestine were determined by the diskdiffusion method.These samples were isolated between June 2006 and December 2007.The minimum inhibitory concentration (MIC) of vancomycin for 115 methicillin resistant Staphylococcus aureus(MRSA) strains was carried out using the agar dilution method.Results:One hundred and fifteen(56.4%) of these isolates were MRSA and according to their antibiotic profile these are multidrug resistant(resistant to three or more non-p-lactam antibiotics). Ninety nine(43.6%) isolates were methicillin sensitive S.aureus(MSSA),forty four of MSSA isolates(44.4%) were multidrug resistant,while forty five(45.6%) were non multidrug resistant.Our results showed that the most common resistance(95.6%) was to penicillin.Two strains of MRSA have shown to be vancomycin- intermediate resistant,had MIC of 4μg/rnL and 8μg/mL and these vancomycin- intermediate resistant S.aureus strains(VISA) are resistant to all antibiotics tested.Conclusion:According to our information this is the first study report about VISA in Palestine.

Antibiotics Susceptibility Profile of Staphylococcus aureus Clinical Isolates Collected in Hospitals in the City of Douala (Cameroon)

Introduction: Staphylococcus aureus is one of the most important agents involved in community and hospital-acquired infections. Due to the multi-drug resistance of strains to antibiotics, treatment to eradicate it is becoming more difficult and poses a global public health problem. Methodology: This was a cross-sectional study conducted from March to August 2020 in hospitals in the city of Douala, including all S. aureus isolates from diagnostic samples. Strain identification and antibiotic susceptibility testing were performed using the Vitek2 CompactTM (BioMerieux). Results: During the study period, 136 non-repetitive S. aureus strains were identified with a high frequency of methicillin-resistant S. aureus of 78.7%. The majority of the strains originated from the Douala General Hospital (66.9%) and was most frequently isolated from blood culture samples (55.1%). The study of biochemical characteristics showed that most of the strains identified had between 87% and 99% homology with the reference strain. The most active antibiotics were Quinupristin/Dalfopristin (94.2%), Linezolid (87.8%) and Vancomycin (84.2%). Methicillin resistance was associated with decreased susceptibility of S. aureus to other antibiotics such as Gentamycin (44.9%), Erythromycin (38.2%), Tetracycline (38.3%), Trimethoprim (21.4%), Ciprofloxacin (19.1%) and Levofloxacin (24.0%). Inducible MLSb and constitutive resistance phenotypes were identified with 26.7% and 22.8% respectively. Conclusion: The sensitivity of S. aureus strains differs from one antibiotic family to another, and remains good for molecules that are not available in our context. The high frequency of Methicillin-Resistant S. aureus shows the continuous progression of multi-resistant strains of S. aureus and their decreased sensitivity to usual antibiotics becomes more and more alarming.

Occurrence of Methicillin-Resistant <i>Staphylococcus aureus</i>in Cheese Produced in German Farm-Dairies

The aim of this study was to determine if raw milk cheese or cheese to be made out of heated milk, manufactured in small German cheese dairies might be a reservoir of contaminations with methicillin-resistant Staphylococcus aureus (MRSA). Due to predominantly manual handling during cheese making, recontaminations with Staphylococcus (S.) aureus or MRSA cannot be excluded. Commercial cheese products (n = 72) available in the region of Hanover(Lower Saxony) and dairy products offered via internet were analyzed with regard to the occurrence of S. aureus and MRSA. Thereof, two cheese samples, manufactured from pasteurized milk and two samples, produced from raw milk, were S. aureus positive with CFU/g between 1.0 × 101 and 7.0 × 101. MRSA was not detected. All analysed cheese samples could be considered safe for consuming.

Rapid Identification of Methicillin Resistant <i>Staphylococcus aureus</i>Using Real Time PCR

Screening for colonization with methicillin resistant Staphylococcus aureas (MRSA) is a key aspect of infection control to limit the nosocomial spread of this organism. Current methods for the detection of MRSA in clinical microbiology laboratories using conventional methods is time consuming. In this research we are trying to evaluate the use of real time PCR for the detection of MRSA. The PCR assay was evaluated in clinical isolates of MRSA (n = 45) and methicillin susceptible Staphylococcus aureas MSSA (n = 10). The diagnostic values of the assay showed high sensitivity and specificity. This real-time PCR assay proved to be a fast, sensitive and specific tool for MRSA detection in a routine microbiological laboratory. Real-time PCR now is available in all laboratories so its use in identification of MRSA will help in shortening the period for MRSA identification and will help in the success of infection control programs in hospitals.

Ophthalmic methicillin-resistant <i>Staphylococcus aureus</i>infections: Sensitivity and resistance profiles of 65 isolates in central California

Purpose: To capture the sensitivity and resistance trends of ophthalmic Methicillin-resistant Staphylococcus aureus (MRSA) in a heterogenous demographic. Methods: Between 1/1/2004-12/31/2011, ophthalmic MRSA infections were searched in the electronic medical record system ofCommunityRegionalMedicalCenterinFresno,California. We reviewed whether the infection was community-acquired or hospital-acquired, culture site, and sensitivity/resistance profiles. Results: The ophthalmic MRSA isolates tested for vancomycin, sulfamethoxazole-trimethoprim, and gentamycin were 100% sensitive to these to these antibiotics. Tetracycline and rifampin had the next highest sensitivity to resistance ratio, followed by clindamycin. More cases were community-acquired than hospital acquired. Almost half of the hospital-acquired cases were in newborns. Most hospital acquired infections were post-ophthalmic surgery. Conclusion: There is an increasing trend of community- acquired ophthalmic MRSA infection with eyelid involvement being the most common manifestation. Hospital-acquired cases are common in newborns and post-ophthalmic surgery. Have a high index of suspicion for MRSA infection with suspected “insect bites”. Vancomycin, sulfamethoxazole-trimethoprim, gentamycin, tetracycline, and rifampin are good choices to treat ophthalmic MRSA infection. There may be emerging resistance to clindamycin, at least in theCentral Californiaregion. If MRSA infection is suspected, erythromycin and fluoroquinolones should be avoided.

Phenotypic Characterization and Risk Factors of Nosocomial <i>Staphylococcus aureus</i>from Health Care Centers

Multidrug resistant Staphylococcus aureus (MDRS) is a serious threat to hospitalized patients globally and now represents a challenge for public health, as community-acquired infections appear to be on the increase in both adults and children. S. aureus colonization has been shown to be a risk factor for community-acquired and nosocomial infections. A total of 130 subjects from the community and 100 subjects from health care-related facilities were evaluated for the prevalence of Staphylococcus aureus colonization and to identify risk factors associated with methicillin-resistant S. aureus (MRSA) and vancomycin resistant S. aureus (VRSA) colonization. Among the community subjects, 35.38% had MRSA and 1.53% VRSA colonization. Subjects from health care-related facilities had a lower MRSA colonization rate (17%) than community subjects and the colonization VRSA has not been found. Age was a risk factor for S. aureus colonization, with subjects under age 20 years or between 60 and 80 years showing higher rates of colonization. In conclusion, a high prevalence of MRSA colonization was observed among people with relationship to the hospital setting. The high level of multiple-drug resistance among community MRSA strains in association with the previously reported excessive use of antibiotics highlights the importance of the problem of antibiotic selective pressure. Our results indicate that the spread of both MRSA and VRSA and the transmission of hospital isolates contribute to the high MRSA/VRSA burden in the community.

Incidence of Methicillin Resistant Staphylococcus aureus in Burn Patients Admitted to Burn Unit, Dhaka Medical

Staphylococcus aureus infection remains an increasing problem for higher morbidity and mortality in burn patients. We sought to determine the frequency of methicillin-resistant S. aureus (MRSA) in burn wound patients and study their drug resistance genes. Samples were collected (August 2010 to October 2011) from burn unit of Dhaka Medical College Hospital (DMCH), Bangladesh. MRSA was identified by conventional culture based methods. S. aureus was confirmed in 44.44% burn wound samples and 22.5% of the isolates were oxacillin resistant. All the S. aureus isolates were resistant to commonly used drugs like amoxicillin, azactam, erythromycin, azithromycin etc. and were sensitive to imipenem. The isolates were devoid of plasmid and the gene mecA, femA and IS431 were detected in their chromosomal DNA. Computational analysis of mecA gene sequence showed homology to S. aureus “penicillin binding protein 2a” (PBP-2a). The higher association of MRSA is in burn unit of DMCH, Bangladesh is alarming and with inappropriate antibiotic use, and the situation gets even complicated to treat. Therefore, the detection system and control practices for MRSA in DMCH should be improved in the hospital settings.

A New Epidemiological Tool for <i>Staphylococcus aureus</i>Surveillance

Epidemiological surveillance for microbes is currently based on either agar culture followed by identification, or genetic amplification. Both techniques are highly skilled-labor intensive, costly, and must be done in central laboratories. The Defined Substrate Utilization&reg;(DSU&reg;) format provides an epidemiological series of specific screening formulations that obviate these limitations. All reagents are present in optimized stable powder form in a test tube—add water, inoculate, and incubate. A specific color change provides a sensitive and specific detection of the target microbe. Two DSU&reg;methods for Staphylococcus aureus (S. aureus) are presented: aureusAlert&reg;for all S. aureus and EPI-M&reg;for methicillin-resistant S. aureus (MRSA). Both aureusAlert&reg;and EPI-M&reg;had a detection level of 20 colony forming units (CFU) in 18 hours. aureusAlert&reg;and conventional methods agreed 93.6% and EPI-M&reg;and conventional methods agreed 94.1%. DSU&reg;and conventional methods showed the same specificity.

Molecular Epidemiology of Oxacillin-resistant Staphylococcus aureus and in vitro Activity of Glycopeptides against Staphylococcus species

The purpose of this subject was to investigate molecular epidemiology of oxacillin-resistant Staphylococcus aureus (MRSA) isolated from hospitalized patients, and to survey the in vitro activity of teicoplanin, vancomycin and other 9 antibiotics against Staphylococcus species . MRSA were detected by oxacillin-NaCl-containing screen agar. The homology of nosocomial MRSA from ICU and RCU was determined by pulse-field gel electrophoresis. Agar diffusion, E test and agar dilution were used to compare the in vitro activity of teicoplanin and vancomycin against Staphylococcus spp from 2001 to 2003 at Peking Union Medical College Hospital. WHONET-5.3 software was used to analyze the antimicrobial susceptibility data. From 2001 to 2003, the prevalences of MRSA were 56.5%, 65.3%, 64.7%, respectively. PFGE found most of MRSA from ICU and RCU were closely related. All of S.aureus and S.epidimidis isolates were susceptible to teicoplanin and vancomycin from 2001 to 2003. However, 1 isolate of S.haemolyticus was resistant and 9 isolates intermediate to teicoplanin. The minimal inhibitory concentration of teicoplanin did not correlate well with zone diameter, when inoculum increased by 100 folds, the zone diameters of teicoplanin decreased more greatly than those of vancomycin. In 2002, severe outbreaks caused by MRSA strains had been found in ICU and RCU wards. Teicoplanin and vancomycin had good activity against clinical isolates of Staphylococci spp . Teicoplanin was less active than vancomycin against S.haemolyticus . Most of S.haemolyticus isolates were intermediate to teicoplanin. Antimicrobial susceptibility testing of teicoplanin was influenced by the diffusion speed in the agar and inoculum size.

Methicillin Resistant Staphylococcus aureus in Pigs and Pig Breeders in Three Regions of Cameroon

The spread of antibiotic resistance, whether in the community or in the hospital, has recently become a major public health problem. Moreover, livestock seems to be a reservoir of resistant microorganisms such as porcine methicillin resistant Staphylococcus aureus (P-MRSA) whose carriage and transmission was mainly demonstrated in persons with occupational exposure to pigs. Much uncertainty remains about the public health implications of P-MRSA. To address concerns that exist regarding the zoonotic risk that pig carriers pose to breeders, the prevalence of P-MRSA in pigs and pig breeders was determined among 152 pig breeders in three regions of Cameroon. Materials and Method: Participants in this study came from Adamawa, Far North and Littoral regions of Cameroon. A total of 152 pig breeders or farm workers participated in this study. After having collected some social and cultural data with the aid of a questionnaire, nasal swabs were collected from pigs (n = 275) and their breeders using the standard collection procedures and placed in cooler containing cold accumulators. For each sample, microbiological assays were done as well as antibiotic susceptibility tests. Results: MRSA was isolated from 25 out of 275 pigs sampled (9.09%) and from 32 out of 152 (21.05%) pig breeders sampled;33 breeders (21.71%) were carriers of S. aureus including 32 MRSA and one MSSA. The prevalence of MRSA nasal carriage was 21.05% ± 6.48. A significant negative association between body protection and nasal carriage of MRSA (OR = 0.29, 95% CI [0.093;0.93];p = 0.04) was observed. In each region, similar strains of MRSA were isolated both in pigs and their breeders with the same antibiotic resistant profile. Conclusion: The prevalence of MRSA though not high compared to European countries warrants further research as data on this zoonosis is scarce in our context. As such, transmission of MRSA from pigs to pig breeders or vice-versa constitutes a real danger, and this relationship may be a starting point for MRSA contamination in the community. Moreover, proper use of body protections and antibiotic medications as recommended will be a better protective measure against nasal MRSA carriage.

Antibacterial Activity of Exogenous Glutathione and Its Synergism on Antibiotics in Methicillin-Associated Multidrug Resistant Clinical Isolates of Staphylococcus aureus

Background: Methicillin-resistant Staphylococcus aureus (MRSA) is one of the most problematic human pathogens. Antibiotic treatment of MRSA often associated with resistance to multiple classes of antibiotics is extremely challenging and urgently demands action to treat MRSA. Glutathione (GSH) is a biogenic thiol-compound that maintains an optimal intracellular redox-potential required for various normal cellular processes. Antibacterial activity of exogenous GSH has been reported in some bacterial pathogens but is largely unknown in MRSA. Aim: This study aimed to understand antibacterial activity of GSH, its role in antibiotic susceptibility, and a potential antibacterial mechanism in clinical isolates of S. aureus. Materials and Methods: Minimum inhibitory concentration (MIC), minimum bactericidal concentration (MBC), checkerboard, time-killing, and bacterial killing assays were performed for 14 clinical isolates of S. aureus including 10 MRSA and two type strains (ATCC 700699 and 35556). Results: MIC and MBC levels for the clinical and type strains were 15 - 20 mM and 25 - 40 mM of GSH, respectively. Subinhibitory concentrations of GSH synergistically enhanced susceptibility of all tested-antibiotics, resulting in sensitizing all-tested S. aureus. Bacterial-killing produced by GSH-mediated acidity was significantly higher than that by hydrochloric acid-mediated acidity. Conclusion: Overall results concluded that GSH exhibited antibacterial activity on S. aureus regardless of antibiotic susceptibility and synergistically enhanced antibiotic susceptibility. Additionally, GSH-mediated acidity was one of the antibacterial mechanisms. These findings suggest that GSH may be a potential antimicrobial agent or adjuvant for the conventional anti-MRSA regimens.

Risk of methicillin-resistant Staphylococcus aureus prosthetic joint infection in elective total hip and knee arthroplasty following eradication therapy

Re-screening following methicillin-resistant Staphylococcus aureus(MRSA) decolonization will be helpful to minimize the development of prosthetic joint infection among MRSA colonizers.

Epidemiology of <i>Staphylococcus aureus</i>Infections in Kenya: Current State, Gaps and Opportunities

Staphylococcus aureus has maintained its clinical relevance as a major cause of hospital and community acquired infections globally with a high burden of antimicrobial resistance (AMR). Though reported, the burden of infection, antimicrobial resistance and molecular epidemiology of S. aureus are not well defined in Kenya. This descriptive review evaluated reported data on the detection and characterization of S. aureus infections in Kenya. Published data between 2000 and 2020 were evaluated. S. aureus isolation frequencies varied from 1% in blood specimens to 52.6% among skin and soft tissues infections while MRSA rates ranged from 1% to 84.1%. While penicillin resistance has consistently been high, last line and recent antibiotics such as vancomycin, linezolid, teicoplanin and daptomycin have retained their efficacy. Data on MRSA carriage in the community, among HCWs and inpatients is limited. Global clones (CC1, CC5, CC8, CC22, CC30, CC45 and CC239) alongside a few novel MRSA strains have been reported with staphylococcal protein A (spa) sequence based clustering yielding four major clusters (spa CC359, spa CC005, spa CC121 and spa CC021) in circulation. MRSA strain ST239/241 (t037) seems predominant in the country. Despite a clear paucity of data, the present analysis points to a high infection and AMR burden in S. aureus with global MRSA clones in circulation. Standardized national surveillance and reporting incorporating molecular tools for identification and characterization will help fill existing gaps in the understanding of the evolving epidemiology of MRSA infections.

基于真实世界研究骨髓炎MRSA感染率的Meta分析

目的:通过Meta分析研究骨髓炎患者中耐甲氧西林金黄色葡萄球菌(MRSA)的感染率。方法:检索PubMed、Web of Science、中国知网、维普、万方和中国生物医学文献数据库(CBM)关于骨髓炎患者MRSA感染率的研究,检索时限为建库至2023年8月。由2位研究人员按照纳入与排除标准对所获文献独立进行筛选、提取,采用纽卡斯尔-渥太华量表评分(NOS)进行文献质量评价。以感染率为结局指标合并数据,采用R(4.3.1)进行Meta分析,并根据骨髓炎类型、患者年龄、研究地区进行亚组分析。结果:共纳入26篇文献,共包含20860名骨髓炎患者。Meta分析结果显示,骨髓炎患者MRSA感染率为0.240(95%CI:0.183~0.297)。亚组分析结果显示,椎体骨髓炎(VO)患者、18~60岁、北美地区骨髓炎患者的MRSA感染率更高。结论:骨髓炎患者中MRSA的感染率较高,需采取有效的预防和控制措施减少MRSA的传播。

皮肤科创面MRSA感染的临床诊断及危险因素分析

目的探讨皮肤软组织分泌物培养出耐甲氧西林金黄色葡萄球菌(MRSA)的相关疾病诊断及导致MRSA感染可能的危险因素,为皮肤科提前防控MRSA感染提供病种预警和危险因素的防治。方法回顾性分析2015年1月~2021年9月我院皮肤性病科皮肤软组织糜烂面分离培养出的MRSA。采用法国生物梅里埃公司的全自动微生物分析鉴定仪(VITEK-2 Compact)鉴定菌种。通过定义入院48小时内或48小时后获得的MRSA阳性培养,将感染分为社区获得性MRSA(CA-MRSA)或医院获得性MRSA(HA-MRSA)。结果(1)皮肤软组织MRSA感染平均占皮肤科多重耐药菌的83.19%,是主要多重耐药菌;(2)皮肤科MRSA感染主要以CA-MRSA感染为主,占71.11%(192/270)。与CA-MRSA感染相关的皮肤病依次为:天疱疮占比最高为28.12%,其次为葡萄球菌性烫伤样皮肤综合征(SSSS)16.67%和药物性皮炎6.77%(其中重症药疹2.08%)等。HA-MRSA感染最常见的也是天疱疮26.92%,其次为药物性皮炎12.82%(其中重症药疹11.54%)和脓疱性银屑病6.41%等;SSSS的CA-MRSA感染率要明显高于HA-MRSA感染(P=0.002);(3)HA-MRSA感染患者使用抗生素的比例明显高于CA-MRSA患者(P=0.001),但在糖皮质激素及免疫抑制剂系统使用上两种MRSA感染没有显著差异。结论皮肤科MRSA感染主要是社区获得性MRSA,MRSA感染最主要的疾病为天疱疮及SSSS,抗生素使用可增加院内感染MRSA的风险。