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Biosurgery (larval therapy) has been used for centuries. However, in recent times, this treatment has been replaced with the use of antibiotics for the treatment of wounds. Due to increasing antibiotic resistance, larval therapy is once again coming to the fore as an effective and efficient treatment. Due to the increasing ageing population, along with an increase in patients with arterial occlusive disease, diabetes and immobility, the number of patients with hardto- heal wounds will increase. The stressors associated with wounds, such as pain, limited physical functionality, depression and social withdrawal, have a negative impact on patient quality of life. This case report documents the performance of biosurgery in a patient with multimorbidities. Declaration of interest: The author has no conflicts of interest to declare. [ABSTRACT FROM AUTHOR]

Background Staphylococcus aureus bacteremia (SAB) disproportionately affects Black patients. The reasons for this disparity are unclear. Methods We evaluated a prospectively ascertained cohort of patients with SAB from 1995 to 2020. Clinical characteristics, bacterial genotypes, and outcome were compared among Black and White patients with SAB. Multivariable logistic regression models were used to determine factors independently associated with the outcomes. Results Among 3068 patients with SAB, 1107 (36%) were Black. Black patients were younger (median, 56 years vs 63 years; P <.001) and had higher rates of diabetes (47.5% vs 34.5%, P <.001), hemodialysis dependence (40.0% vs 7.3%, P <.001), and human immunodeficiency virus (6.4% vs 0.6%, P <.001). Black patients had higher rates of methicillin-resistant S. aureus (49.3% vs 44.9%, P =.020), including the USA300 hypervirulent clone (11.5% vs 8.4%, P =.007). White patients had higher rates of corticosteroid use (22.4% vs 15.8%, P <.0001) and surgery in the preceding 30 days (28.1% vs 18.7%, P <.001). Although the median Acute Physiology Score (APS) at the time of initial SAB diagnosis was significantly higher in Black patients (median APS, 9; interquartile range [IQR], 5–14 vs median APS, 7; IQR, 4–12; P <.001), race was not associated with 90-day mortality (risk ratio, 1.02; 95% confidence interval,.93–1.12), and rates of metastatic infection were lower among Black patients (37.2% vs 41.3% White, P =.029). Conclusions Despite differences in Black patients' higher APS on presentation and more risk factors, including a 5 times higher risk of hemodialysis dependence, 90-day mortality among Black and White patients with SAB was similar. [ABSTRACT FROM AUTHOR]

Periprosthetic joint infections are a devastating complication of joint replacement surgery. One novel therapeutic that has potential to change the current treatment paradigm is bacteriophage therapy. Herein, we discuss our experiences with bacteriophage therapy for 10 recalcitrant periprosthetic joint infections and review the treatment protocols utilized to achieve successful outcomes. [ABSTRACT FROM AUTHOR]

The warm season essential oil producing grass species including lemongrass (Cymbopogon citratus), palmarosa grass (C. martini), geranium grass (C. schoenanthus), vetiver grass (Chrysopogon zizanioides), and scented top grass (Capillipedium parviflorum) are used worldwide for their cosmetic and health properties. A discussion providing evidence from literature reviews about the potential uses of these grass species for antimicrobial and other health uses are presented. These species could be used as new therapies for treating microbial infections. The purpose of this study is to discuss in detail, evidence from literature reviews supporting potential health uses and to provide some discussion regarding some agronomic traits for these essential oil producing species. [ABSTRACT FROM AUTHOR]

Background: Treatment of open fractures remains a significant challenge in trauma care as these fractures are accompanied by extensive soft tissue damage, exposing the wound site to contaminants and increasing infection risk. Formation of biofilm, a capsule-like environment that acts as a barrier to treatment, is a primary mode by which infecting pathogens persist at the wound site. Therefore, a pressing need exists to identify irrigation methods that can disrupt biofilm and expose pathogens to treatment. This study aims to evaluate the antibiofilm wound lavage, Bactisure™, in comparison with saline for care of severe musculoskeletal wounds and elucidate potential effects on antibiotic treatment success. Methods: UAMS-1 Staphylococcus aureus biofilms were formed in vitro and treated with Bactisure™ wound lavage or sterile normal saline, alone, or in combination with sub-biofilm inhibitory levels of vancomycin. Characterization methods included quantification of biofilm biomass, quantification of viable biofilm bacteria, and biofilm matrix imaging. For in vivo assessment, a delayed treatment model of contaminated open fracture was used wherein a critical-sized defect was created in a rat femur and wound site inoculated with UAMS-1. Following a 6 h delay, wounds were debrided, irrigated with lavage of interest, and antibiotic treatments administered. Bacterial enumeration was performed on bone and hardware samples after two weeks. Results: An immediate reduction in biofilm biomass was observed in vitro following antibiofilm lavage treatment, with a subsequent 2- to 3- log reduction in viable bacteria achieved after 24 h. Furthermore, biofilms treated with antibiofilm lavage in combination with vancomycin exhibited a minor, but statistically significant, decrease in viable bacteria compared to irrigation alone. In vivo, a minor, not statistically significant, decrease in median bioburden was observed for the antibiofilm lavage compared to saline when used in combination with antibiotics. However, the percentage of bone and hardware samples with detectable bacteria was reduced from 50 to 38%. Conclusions: These results suggest that the antibiofilm wound lavage, Bactisure™, may hold promise in mitigating infection in contaminated musculoskeletal wounds and warrants further investigation. Here, we proposed multiple mechanisms in vitro by which this antibiofilm lavage may help mitigate infection, and demonstrate this treatment slightly outperforms saline in controlling bioburden in vivo. [ABSTRACT FROM AUTHOR]

Staphylococcal toxic shock syndrome (TSS) is a severe systemic disease characterized by fever, hypotension, desquamating rash, and multiorgan dysfunction. Attributed to bacterial exotoxins, TSS has been a known, though rare, complication in the field of pediatric burns for decades. The adoption of new antimicrobial burn dressings has allowed for the management of small to medium sized burns with minimal discomfort or inconvenience to the patient. In this report, we discuss a 3-year-old male with burns wounds dressed using a silver-impregnated foam who went on to develop TSS. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Over the last decades, the problem of formation and circulation of micro-organisms with resistance to antimicrobials has been steadily increasing. Hospital-acquired infections (HAI) are one of the most pressing problems in medicine, urgency of which is associated with high rates of morbidity, mortality, and significant socio-economic losses. OBJECTIVES: The aim of the study was to investigate antimicrobial activity of commercial disinfectants on typical and clinical isolates of bacteria of genus Staphylococcus. MATERIAL AND METHODS: Clinical base for isolation of bacteria was the University Dental Clinic of Uzhhorod National University, and evaluation of antimicrobial activity of disinfectants was conducted in microbiological laboratory of the Department of Genetics, Plant Physiology and Microbiology of Uzhhorod National University, Ukraine. Sensitivity of micro-organisms to disinfectants was determined using standard method of diffusion into agar (well diameter, 8 mm). RESULTS: Previous studies have shown that in vitro experiments, the highest anti-staphylococcal effect was observed using Ecobriz antiseptic, AHD 2000, and Lysoformin 3000. It should be noted that sensitivity of coagulasenegative staphylococci was statistically significantly higher than that of coagulase-positive. Thus, the growth retardation zone under the action of AHD 2000 on clinical strain of Staphylococcus aureus was 19.0 ± 0.30 mm and on S. haemolyticus it was 23.9 ± 1.0 mm. This trend was characteristic for other antiseptics. The lowest antimicrobial activity was detected by using Chlorhexidine. Antimicrobial action of ethanol at applied dose was not observed. The highest activity among staphylococci was detected using antiseptics on S. hominis isolates. CONCLUSIONS: Experiments established antimicrobial activity of all antiseptics except Dezoderm and Etasept. The highest level of activity against Gram-positive, Gram-negative bacteria, and microscopic fungi was found in Bacylol. High levels of antimicrobial activity were detected using AHD 2000, Lysoformin 3000, Ecobriz antiseptic, and Famidez, with higher activity of antiseptics against bacteria of genus Staphylococcus. [ABSTRACT FROM AUTHOR]

Background To examine the impact of infectious diseases consultation (IDC) on the management and outcome of Staphylococcus aureus bacteremia (SAB) in children. Methods A retrospective cohort study of children with SAB at a teritary pediatric hospital (January 2009-June 2015) identified by medical record review as to whether they received an IDC for SAB at the discretion of the admitting physician or surgeon was conducted. Differences in management and outcomes for those with and without IDC were evaluated, and multivariate regression analysis was used to determine factors associated with cure. Results There were 100 patients included in the analysis. Fifty-five patients received IDC and 45 had no IDC (NIDC). Appropriate directed therapy within 24 hours (54/55 = 98.2% vs 34/45 = 75.6%, P  < .01), choice (54/55 = 98.2% vs 37/45 = 82.2%, P  < .01), dose (54/55 = 98.2% vs 36/45 = 80%, P  < .01), and duration (52/55 = 94.5% vs 24/45 = 53.3%, P  < .01) of directed antibiotic therapy were appropriate in more IDC group patients. Achievement of source control in indicated cases was also more common in the IDC group (28/32 = 87.5% vs 5/26 = 19.1%, P  < .01). Appropriate investigation with repeat blood cultures and echocardiograms was not significantly different. All 55 patients in the IDC group had a complete response (cure) compared with 40 of the 45 (88.9%) patients in the NIDC group: 2 patients died and 3 patients had a relapse of infection with subsequent cure. In multivariate regression analysis, methicillin-susceptible SAB and IDC were factors independently associated with cure. Conclusions Children who received IDC for SAB in a tertiary pediatric setting were more likely to have appropriate investigations and management and had improved outcomes. [ABSTRACT FROM AUTHOR]

Background: Palliative care consultation has shown benefits across a wide spectrum of diseases, but the utility in patients with Staphylococcus aureus bacteremia remains unclear despite its high mortality. Aim: To examine the frequency of palliative care consultation and factors associated with palliative care consult in Staphylococcus aureus bacteremia patients in the United States. Design: A population-based retrospective analysis using the Nationwide Inpatient Sample database in 2014, compiled by the Healthcare Costs and Utilization Project of the Agency for Healthcare Research and Quality. Setting/subjects: All inpatients with a discharge diagnosis of Staphylococcus aureus bacteremia (ICD-9-CM codes; 038.11 and 038.12). Measurements: Palliative care consultation was identified using ICD-9-CM code V66.7. Patients' baseline characteristics and outcomes were compared between those with and without palliative care consult. Results: A total of 111,320 Staphylococcus aureus bacteremia admissions were identified in 2014. Palliative care consult was observed in 8140 admissions (7.3%). Palliative care consultation was associated with advanced age, white race, comorbidities, higher income, teaching/urban hospitals, Midwest region, Methicillin-resistant Staphylococcus aureus bacteremia and the lack of echocardiogram. Palliative care consult was also associated with shorter but more expensive hospitalizations. Crude mortality was 53% (4314/8140) among admissions with palliative care consult and 8% (8357/10,3180) among those without palliative care consult (p < 0.001). Conclusions: Palliative care consultation was infrequent during the management of Staphylococcus aureus bacteremia, and a substantial number of patients died during their hospitalizations without palliative care consult. Given the reported benefit in other medical conditions, palliative care consultation may have a role in Staphylococcus aureus bacteremia. Selecting patients who may benefit the most should be explored. [ABSTRACT FROM AUTHOR]

This research was conducted to evaluate the antibacterial activity of pumpkin (Cucurbita pepo L.) seeds extract against pathogenic Staphylococcus aureus in vitro. The study included antibacterial activity of (Cucurbita pepo L.) seeds extract, which consisted of two steps: the first step; isolation and identification of Staphylococcus aureus andpreparation of standard bacterial suspension, the second step; preparation of (Cucurbita pepo L.) seeds extract according to maceration technique, evaluation the phytoconstituents of (Cucurbita pepo L.) seeds extract and then preparation of different concentrations of pumpkin seeds extract. The results in vitro study showed the yield percentage of cucurbita pepo seeds extract was 24% and the chemical analysis of pumpkin seeds extract proved the presence of alkaloid, flavonoid, phenol, saponin, tannin, terpenoid and steroid. Sensitivity test revealed that S. aureus was more sensitive to ethanolic extract of pumpkin seeds in different concentration. (100, 80, 40, 20 and 10) mg/ml caused different degrees of zones of inhibition against S. aureus 23.0±0.91, 19.0±0.73, 15.0±0.38, 12.0±0.77 and 10.0±0.36, respectively. In addition, the MIC of pumpkin seeds extract was 0.625 mg/ml. This antibacterial activity of the ethanolic extract of pumpkin seeds may be due to Its secondary metabolite components which are responsible for various mechanisms of action of antibacterial activity [ABSTRACT FROM AUTHOR]

Background: Pyogenic flexor tenosynovitis is a debilitating infection of the hand flexor tendon sheath with high morbidity despite standard treatments of empiric antibiotics with irrigation and debridement. In vivo studies in the available literature have used avian models, but these models are difficult to scale and maintain. The purpose of this study was to demonstrate the plausibility of a murine model of pyogenic flexor tenosynovitis utilizing bioluminescence imaging and tissue analysis at harvest.Methods: A 2-μL inoculate of bioluminescent Xen29 Staphylococcus aureus or sterile phosphate-buffered saline solution (sPBS) was administered to the tendon sheath of 36 male C57BL/6J mice. The infectious course was monitored by bioluminescence imaging (BLI) via an in vivo imaging system, gross anatomic deformity, and weight change. The infected hind paws were harvested at 4 time points: 24 hours, 72 hours, 1 week, and 2 weeks for histological analysis using Alcian blue, hematoxylin, and Orange-G staining. Two-way analysis of variance with the Sidak multiple comparison test was used to assess differences in bioluminescence and weight at each time point.Results: The infected cohort displayed significantly elevated bioluminescence values, had reductions in weight, and exhibited swelling of the infected digit throughout the course of infection. By day 4, most infected mice saw a substantial decrease in BLI signal intensity; however, 2 infected mice exhibited persistent BLI intensity through day 14. Histological analysis of the infected cohort showed tissue disorganization and the presence of a cellular infiltrate in and around the flexor tendon sheath.Conclusions: A murine model of pyogenic flexor tenosynovitis is possible and can serve as an experimental platform for further investigation of the pathophysiology of pyogenic flexor tenosynovitis.Clinical Relevance: This animal model can be utilized in elucidating the basic molecular and/or cellular mechanisms of pyogenic flexor tenosynovitis while simultaneously evaluating novel therapeutic strategies. [ABSTRACT FROM AUTHOR]

Staphylococcus genus is a Gram-positive coccus normally associated with skin and mucous membranes of warm-blooded animals. It is part of the commensal human microflora, or found in animals, or contaminating surfaces in the community and hospital settings. Staphylococcus aureus is the most pathogenic species belonging to this genus, as it possesses a collection of virulence factors that are expressed solely to evade the immune system. The increase in the misuse of antimicrobial agents predisposed S. aureus to develop antibiotic resistance, including the resistance to methicillin which led to the emergence of Methicillin-Resistant S. aureus (MRSA). MRSA is considered one of the most dangerous nosocomial pathogens causing many hard to treat infections in hospitals and was named as Hospital Associated MRSA (HA-MRSA). Over the past 20–25 years, MRSA was isolated from community settings and thus Community Associated MRSA (CA-MRSA) has emerged. Inside hospitals, MRSA has been isolated from fomites in contact with patients, as well as staff's protective and personal items. This review highlights the worldwide prevalence of MRSA on fomites within the contexts of hospital and community settings. [ABSTRACT FROM AUTHOR]

The study was aimed to explore the differences between the Staphylococcus aureus osteosynthesis-associated infection (OAI) and non-implant related infections (NIRI) in terms of epidemiology, resistance characteristics, virulence determinants, treatment, risk factors, and outcome. A prospective study was conducted from 2018 through 2019. The phenotypic and genotypic characterization of S. aureus, risk factors, treatment, and outcome were compared. A total of 60 patients were included. 50% had OAIs (70%) (p =.045). Overall, MRSA (OR 0.69; p =.020) and old age (OR 0.95; p = 0.035) were the important risk factors. Implanted patients presented with the features of chronic osteomyelitis (93.3%, p = 0.01). NIRI cases composed of only 66.7% of OM, and 55% of them were acute. OAI isolates were more frequently luk gene positives (50%) than isolates from the NIRI group (33.3%). Patients with OAI by luk positive isolates significantly had prolonged hospital stay (p = 0.043; OR-0.96, CI-0.91–1.0). Most of the NIRIs (60%) managed with antibiotics, but frequent surgical intervention (OR 10.68; p =.024) with prolonged systemic antibiotics (OR 1.07; p =.029) helped all OAIs to recover. Patients without implants were recovered in a higher number (83.3%). Our study highlighted that the differences exist between the OAI and NIRI, specifically in terms of clinical features, distribution of luk genes, treatment approach, and outcome. Risk factors for both types of infection remained the same. [ABSTRACT FROM AUTHOR]

Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) is a major public health concern for Indigenous pediatric populations worldwide. It is the leading cause of skin and soft tissue infections in this demographic. This article reviews the literature and presents an evidence-based algorithm for the assessment and management of CA-MRSA among Indigenous children in remote settings. [ABSTRACT FROM AUTHOR]

Staphylococcus aureus is a common cause of community and health care--associated bacteremia, with authors of recent studies estimating the incidence of S aureus bacteremia (SAB) in high-income countries between 8 and 26 per 100 000 children per year. Despite this, <300 children worldwide have ever been randomly assigned into clinical trials to assess the efficacy of treatment of SAB. A panel of infectious diseases physicians with clinical and research interests in pediatric SAB identified 7 key clinical questions. The available literature is systematically appraised, summarizing SAB management in children in relation to these priority clinical questions. The management of neonates, children, and adolescents with SAB is predominantly based on clinical experience and trial data extrapolated from adult studies, with limited high-quality evidence available to guide management. The optimal, comprehensive management strategies for SAB in children will remain unknown until the questions outlined are answered through prospective observational cohorts and inclusion of children with SAB in clinical trials. [ABSTRACT FROM AUTHOR]

Background: To mitigate the possibility of infection after arthroplasty, intraoperative irrigation is essential to remove contaminating bacteria. Previous studies have demonstrated that irrigation with an EDTA solution before wound closure is superior to irrigation with normal saline in removing contaminating bacteria in a rat model of open fractures. However, the effectiveness of an EDTA solution in a model with a contaminated intra-articular implant remains unclear.Questions/purposes: (1) Does irrigation with an EDTA solution decrease the proportion of culture-positive joints compared with normal saline, benzalkonium chloride, and povidone iodine? (2) Is an EDTA solution toxic to cells resident in joints including chondrocytes, osteoblasts, and synovial fibroblasts? (3) Does irrigation with an EDTA solution have adverse effects including arthrofibrosis and hypocalcemia?Methods: We first established a model of contaminated intra-articular implants. Female Sprague-Dawley rats (n = 30 for each treatment group) underwent knee arthrotomy and implantation of a femoral intramedullary wire with 1 mm of intra-articular communication. To simulate bacterial contamination, the inserted wire was inoculated with either Staphylococcus aureus or Escherichia coli. After 1 hour, the wound and implant were irrigated with normal saline, benzalkonium chloride, povidone iodine, or an EDTA solution (1 mM). The animals were euthanized 1 week later, and the distal femur, knee capsule, and implanted wire were harvested for bacterial culture using standard techniques. In this study, we used a well-established animal model of an intra-articular implant and inoculated the implant to simulate the clinical setting of intraoperative contamination. The proportion of culture-positive joints in normal saline, benzalkonium chloride, povidone-iodine, and EDTA groups were compared. The viable cell numbers (chondrocytes, osteoblasts, and synovial fibroblasts) were counted and compared after treatment with either solution. Measurement of blood calcium level and histological examination of the joint were performed to rule out hypocalcemia and arthrofibrosis after EDTA irrigation.Results: With S. aureus inoculation, EDTA irrigation resulted in fewer culture-positive joints than normal saline (37% [11 of 30] versus 70% [21 of 30]; p = 0.019), benzalkonium chloride (83% [25 of 30]; p < 0.001), and povidone iodine (83% [25 of 30]; p < 0.001) irrigation. Likewise, infection rates for implant inoculation with E. coli were also lower in the EDTA irrigation group (13% [four of 30]) than in the normal saline (60% [18 of 30]; p < 0.001), benzalkonium chloride (77% [23 of 30]; p < 0.001), and povidone iodine (80% [24 of 30]; p < 0.001) groups. Between normal saline control and EDTA, there were no differences in cell viability in chondrocytes (normal saline: 98% ± 18%; EDTA: 105% ± 18%; p = 0.127), osteoblasts (normal saline: 102 ± 19%, EDTA: 103 ± 14%; p = 0.835), and synovial fibroblasts (normal saline: 101% ± 21%, EDTA: 110% ± 13%; p = 0.073). EDTA irrigation did not result in hypocalcemia (before irrigation: 2.21 ± 0.32 mmol/L, after irrigation: 2.23 ± 0.34 mmol/L; p = 0.822); and we observed no arthrofibrosis in 30 histologic samples.Conclusions: In a rat model of a bacteria-contaminated intra-articular implants, intraoperative irrigation with 1 mmol/L of an EDTA solution was superior to normal saline, 0.03% benzalkonium chloride, and 0.3% povidone iodine in preventing surgical-site infection and caused no adverse effects including death of resident cells, arthrofibrosis, and hypocalcemia. Future studies should seek to replicate our findings in other animal models, perhaps such as dog and goat.Clinical Relevance: If other animal models substantiate the efficacy and safety of the EDTA solution, clinical trials would be warranted to determine whether the use of an EDTA irrigation solution might reduce the risk of periprosthetic joint infections in patients compared with traditional irrigation solutions. [ABSTRACT FROM AUTHOR]

Background: Emergence and prevalence of multi drug resistance strains such as Methicillin-Resistant Staphylococcus aureus (MRSA) call for new antibacterial option. Endolysins as a new option is suggested. The phage display technique is suggested for production of recombinant endolysins. The recombinant endolysins displayed nano phages specifically lysis bacteria, which penetrate to the depth of tissue and the effective dose is reduced. Methods: CHAPK gene was ligated in T7Select vector arms in T7Select10-3b cloning kit. To produce recombinant nano phages, ligation reaction was added directly to the packaging extract. Recombinant nano phages were amplified by Double Layer Agar assay (DLA). The recombinant nano phages were characterized using TEM. Size of recombinant nano phages was determined using DLS. The spot test was performed to confirm CHAPk -displayed on the surface of nano phages. The turbidimetry was used to investigate lytic activity of recombinant nano phages against MRSA ATCC No. 33591. Results: The results showed recombinant nano phages belonged to order Caudovirales and family Podoviridae with titer 2x107 PFU/ml. According to the results of DLS, size of recombinant nano phages was 71 nm. Formation inhibition zone confirmed the presence of CHAPk on the surface of nano phage phenotypically. The turbidimetry showed lytic activity recombinant nano phages against MRSA after 5 min. Conclusion: This study suggests that CHAPk -displayed nano phages can be effective in MRSA infections. [ABSTRACT FROM AUTHOR]

This study is designed to detect the biological activity of Marjoram leaves against Staphylococcus aureus bacteria isolated from boxing students and the tools used by them of the second stage in the College of Physical Education and Sport Sciences, ALMustansiriyah University. This is done by preparing an aqueous extract of Marjoram leaves and using the Agar method. Then, the extract is compared to the sterile distilled water as a control. The inhibitory results of the extract were studied in various concentrations against Staphylococcus bacteria. The results showed an excellent inhibition area against this type of bacteria. The present studyconcludes the safe use and biological effectiveness of this extract, which can be used as a drug against such bacteria. [ABSTRACT FROM AUTHOR]

Background: Necrotizing fasciitis is a major health problem throughout the world. The purpose of this review is to assist providers with the care of these patients through a better understanding of the pathophysiology and management options. Methods: This is a collaborative review of the literature between members of the Surgical Infection Society of North America and World Society of Emergency Surgery. Results: Necrotizing fasciitis continues to be difficult to manage with the mainstay being early diagnosis and surgical intervention. Recognition of at-risk populations assists with the initiation of treatment, thereby impacting outcomes. Conclusions: Although there are some additional treatment strategies available, surgical debridement and antimicrobial therapy are central to the successful eradication of the disease process. [ABSTRACT FROM AUTHOR]

Introduction: The Masquelet procedure proved its efficiency in treating infected nonunion filling bony gaps up to 25 cm. Yet the use of local antibiotics is still questionable in the daily practice with lack of evidence regarding its usefulness in controlling infection. An experimental rat model is put in place to study the antibacterial properties of the induced membrane produced during the first stage of Masquelet.Method: Twenty-three-month-old wistar male rats are inoculated with a 0.5 mL solution of 10^8 CFU/mL MRSA over a critical fracture done on the right femur. Six weeks later, remaining 11 rats exhibiting signs of a chronic infection with a sinus tract and oozing pus along with radiological nonunion are used for a first stage Masquelet procedure. They are randomly divided into two groups with six rats having no local antibiotic in the cement mixture and five rats having 3 g of vancomycin mixed with gentamycin loaded cement. Six weeks later (twelve weeks from baseline), all eleven rats are euthanized and blood samples for C-reactive protein are withdrawn. The induced membrane is identified and resected along with bone fragments and sent for cultures and pathology.Results: MRSA is isolated in the cultures of all six rats in the first group where no local antibiotic was added. Altered polymorphonuclears with abscess and pus are noted on four of six pathology samples. However in the second group where local antibiotics were added, three out of five rats exhibited eradication of MRSA (p = 0.034) and all samples did not exhibit clear infection signs on pathology. A pyo-epithelioid over a foreign body reaction is seen predominantly in this group demonstrating a regenerative process.Discussion: The induced membrane does not have antimicrobial properties capable of overcoming an infected nonunion on its own. When local antibiotics were added during the first stage of the Masquelet procedure, new bone formation occurred indicating the need to control an infection in order for bone union to occur.Conclusion: Local antibiotics use in adjunction to extensive debridement is advisable during the first stage of a Masquelet procedure for an infected nonunion. [ABSTRACT FROM AUTHOR]

Introduction: Primary breast abscesses occur in <1% of non-lactating women, rising to 11% in women with lactational mastitis. In patients undergoing breast cancer surgery, the inflammatory response to post-operative surgical site infection (SSI) has been implicated in recurrence. Anti-microbial resistance increasingly hampers treatment in each group.Aims: Describe the demographic and predisposing characteristics of patients with primary breast abscesses and secondary infections, identify the microbial and antimicrobial patterns and formulate an evidence-based protocol for treating breast infections.Methods: Retrospective cohort study of all breast infections (primary and post-operative) treated at UHL from 2014 to 2017. Data collected from microbiology databases and patient records was analysed using Minitab V18.Results: 537 cultures from 108 patients were analysed. 47 (43.5%) had primary abscesses, 12 (11.1%) were lactational and 49 (45.4%) were post-operative SSI. For primary infections, the mean age was 41.9 (±12.2) and reinfection rate 33%. For SSIs the mean age was 51.8 (±14.52) and reinfection rate 11.8%. Overall, 29.3% were smokers, 6.4% diabetic and 2.9% pregnant. 60 (43%) patients required radiological drainage and 2 (1%) surgical drainage. 57.5% had mixed growth. The most common isolate was Staphylococcus aureus; cultured in 16.7% of primary abscesses and 24% of SSIs. 13 empiric antibiotic regimes were prescribed before 26.4% of patients changed to 12 different targeted regimes.Conclusion: Breast infections are frequently polymicrobial with a wide variety of organisms isolated, suggesting the need for broad spectrum coverage until culture results become available. Based on our local culture results, the addition of clindamycin to flucloxacillin would provide excellent empiric coverage for all categories of breast infection. An evidence-based treatment guideline is required and should be formulated in close collaboration with microbiology specialists. [ABSTRACT FROM AUTHOR]

Background: Septic arthritis of the elbow joint is a rare condition. Limited data is available on infections of the elbow joint following trauma or prior surgery on this joint. The aim of this study was to describe the etiology, comorbidities, bacterial spectrum and therapy of secondary purulent elbow infections.Methods: Patients treated in our hospital were selected through retrospective chart review between 2006 and 2015. We included all patients with an empyema of the elbow after a trauma or surgical intervention on this joint. 30 patients between 26 and 82 years (mean: 52.47) were included.Results: Seven patients (23.3%) were female, 23 (76.7%) male. 22 patients (73.3%) had a history of trauma, eight (26.7%) had prior elective surgeries on their elbow. Between one and 25 surgeries (mean: 5.77) were necessary for treatment. In nine patients, debridement and synovectomy were sufficient, eight patients (26.7%) received resection of the elbow joint. One patient was treated with a chronic fistula. In 18 patients (60%), cultures of aspiration/intraoperative swabs were positive for Staphylococcus aureus, four of these were methicillin-resistant. Four patients (13.3%) had positive cultures for Staphylococcus epidermidis, in five patients (16.7%) no bacteria could be cultured.Conclusions: Secondary infections of the elbow joint are a rare disease with potentially severe courses, requiring aggressive surgical treatment and possibly severely impacting elbow function. Staphylococcus aureus was the most common bacteria in secondary infections and should be addressed by empiric antibiotic treatment when no suspicion for other participating organisms is present. [ABSTRACT FROM AUTHOR]

Background little is known on the clinical implications of vancomycin trough levels among older patients. Objective to evaluate the association between vancomycin levels and outcomes among older versus younger patients. Design retrospective study. Subjects patients aged 18–64 and ≥65 years treated with vancomycin for documented methicillin resistant Staphylococcus aureus (MRSA) infections. Methods we compared the effectiveness and toxicity of vancomycin according to trough levels in older versus younger patients. Subgroup analysis of patients with glomerular filtration rate (GFR) > 60 ml/min/1.73 m2 was performed. Results we included 181 patients aged ≥65 years and 104 younger patients. Mean age in the older group was 76.9 ± 8 years versus 50.9 ± 12.4 in the younger group. Vancomycin trough levels and 24-hours area under the curve to minimal inhibitory concentrations (AUC/MIC) were significantly higher in older patients who were also significantly more likely to achieve trough levels of ≥15 mg/l within 4 days, (98/181 (54.1%) vs. 38/104 (36.5%) in younger patients, P  = 0.004). Results were similar among patients with GFR > 60. Thirty-day mortality was significantly higher in older (74/181, 40.9% vs. 13/104, 12.5%, respectively, P  < 0.001). There was no association between vancomycin trough levels and mortality among older patients. No significant differences were demonstrated in clinical or microbiological success or nephrotoxicity. Conclusions applying uniform dosing recommendations across age groups among adults with MRSA infections results in higher vancomycin levels and AUC/MIC in older versus younger patients. Yet, mortality rates remain higher among older adults. Prospective studies are needed to define the optimal approach for using this drug in older patients. [ABSTRACT FROM AUTHOR]

Background/Objectives: In the dental environment, handpiece or ultrasonic scaler used in treatment causes aerosols and various pathogenic microorganisms. Many types of pathogens cause infectious diseases. This study is to identify surface disinfectants suitable for the management of Staphylococcus saprophyticus bacterial species, one of the causes of infection in medical institutions to use them as standardized surface management resources for infection control in dental clinic. Method/Statistical Analysis: Commonly used 7 types of disinfectants were classified to select commercialized disinfectants. Samples were taken by rubbing the surface of the unit chair with a sterile swab. In order to check the bacterial species cultured in the medium, a single colony was purely separated by streaking. To identify the bacterial species, DNA was extracted from the bacteria and PCR was performed. the mean and standard deviation of each group. One-way ANOVA and Scheffe's post-test were carried out to identify the clear zone of paper discs and significant differences between groups. Findings: The test for bacterial identification was carried out for the surface flora of the unit chair. As a result, S. saprophyticus was identified on the surface. According to the result of comparative analysis of the clear zone size of each disinfectant, sodium hypochlorite (NaOCl), a chlorine disinfectant was found to have the highest disinfection effect (8.52mm), followed by Distell, an ammonium compound disinfectant (2.72). Improvements/Applications: The result of the analysis of the clear zone of the disinfectant showed excellent antibacterial activity in 0.3% NaOCl and 0.5% Distel, indicating that they are disinfectants suitable for S. saprophyticus used in the study. [ABSTRACT FROM AUTHOR]

• Ceftriaxone is a commonly used empirical antibiotic for the treatment of pneumonia. • Observational studies found conflicting results on the efficacy of ceftriaxone for MSSA infection. • Meta-analysis of RCTs comparing clinical cure in pneumonia patients receiving ceftriaxone vs. ceftaroline or ceftobiprole. • Ceftriaxone increased the absolute risk of clinical failure in patients with MSSA pneumonia vs. ceftaroline/ceftobiprole. • Ceftriaxone is not an ideal agent for treatment of MSSA infections, with new evidence against its use for MSSA pneumonia. Ceftriaxone is an empirical antibiotic commonly used to treat pneumonia. However, its use to treat infections caused by methicillin-susceptible Staphylococcus aureus (MSSA) is controversial given limited evidence of its clinical efficacy. The objective of this study was to compare the clinical efficacy of ceftriaxone with either ceftaroline or ceftobiprole in the treatment of pneumonia caused by MSSA. A systematic review and meta-analysis of randomised controlled trials (RCTs) comparing clinical cure in patients with pneumonia who received ceftriaxone versus those who received either ceftaroline or ceftobiprole was conducted. Patients who received ceftriaxone plus vancomycin were excluded. The PubMed, Embase and Cochrane Library databases as well as clinical trial registries were searched up to 8 June 2018. Risk differences (RDs) with 95% confidence intervals (CIs) were estimated using a random-effects model and assessing for heterogeneity (I 2). A total of five RCTs met the inclusion criteria; four used ceftaroline and one used ceftobiprole. Four studies included adults and one included paediatric patients. The adult studies included non-intensive care unit patients with mild-to-moderate community-acquired pneumonia. Clinical cure was statistically lower with ceftriaxone (RD, –28.5%, 95% CI –53.5% to –3.4%; P = 0.026; I 2 = 16.321%) than with ceftaroline or ceftobiprole. In conclusion, ceftriaxone use was associated with higher clinical failure of MSSA pneumonia compared with ceftaroline or ceftobiprole. This supports the notion that ceftriaxone is not an ideal agent for the treatment of MSSA infections and adds new evidence against its use for MSSA pneumonia. [ABSTRACT FROM AUTHOR]

Objective: To determine whether there are differences in the outcomes of native joint septic arthritis (SA) in adults, based on medical versus surgical management.Methods: A 10-year retrospective single-center study was conducted of patients admitted to a tertiary care hospital between January 1, 2006 and December 31, 2015 with a diagnosis of SA to compare outcomes based on the management approach taken: medical (bedside closed-needle joint aspiration) versus surgical (arthrotomy/arthroscopy). Evaluated outcomes included joint recovery, time to recovery, length of stay, disposition to home versus rehabilitation unit, recurrence of SA in the same joint, and mortality.Results: Of 118 confirmed cases of SA, 48 were in prosthetic joints and 70 were in native joints, and 61 met our inclusion criteria. Forty-one (67%) patients received surgery, and 20 (33%) received closed-needle aspiration. There was no statistically significant difference in long-term outcomes between the two groups at 12 months. Patients managed medically were more likely to experience full recovery at 3 months and were less likely to need short-term rehabilitation.Conclusions: Medical management with closed-needle aspiration may be an adequate approach to the treatment of native joint infections. [ABSTRACT FROM AUTHOR]

Background: Despite significant advancements in surgical protocols and biomaterials for orthopedics, peri-prosthetic joint infection (PJI) remains a leading cause of implant failure. Staphylococcus aureus nasal colonization is an established risk factor for PJI, with methicillin-sensitive S. aureus a leading cause of orthopedic implant-related infections. The purpose of these in vitro studies was to investigate the antibacterial activity of a tailored bacteriophage cocktail against planktonic and biofilm-associated S. aureus.Methods: The S. aureus strains (n = 30) were screened for their susceptibility to a library of S. aureus-specific bacteriophage (n = 31). Five bacteriophage preparations that demonstrated bactericidal activity against >90% of S. aureus strains tested were combined as a StaPhage cocktail and assessed for their antibacterial activity toward planktonic and biofilm-associated S. aureus, with biofilms established on three-dimensional-printed porous titanium scaffolds.Results: StaPhage treatment immediately after bacterial inoculation inhibited growth of S. aureus by >98% in eight hour cultures when multiplicity of infection of phages to bacteria was greater than 1:1 (p < 0.01). Viable bacterial numbers within biofilms on titanium surfaces were significantly reduced (6.8 log10 to 6.2 log10 colony forming units [CFU]; p < 0.01) after exposure to the StaPhage cocktail, in vitro. No significant reduction was observed in biofilms exposed to 100 times the minimal inhibitory concentration of cefazolin (log10 6.81 CFU).Conclusions: Combined, these data demonstrate the in vitro efficacy of S. aureus-specific bacteriophage cocktails against S. aureus growing on porous titanium and warrant further in vivo studies in a clinically relevant animal model to evaluate the potential application of bacteriophage in the management of PJI caused by S. aureus. [ABSTRACT FROM AUTHOR]

Background: Irrigation and débridement are frequently utilized in the management of surgical infections, but even with aggressive débridement, it is difficult to remove all the suture material from the tissues and retained suture material may harbor bacteria and/or biofilm. The degree to which barbed or braided sutures may differentially influence the risk of infection has not been defined in a well-controlled animal model.Questions/purposes: We compared braided and barbed monofilament sutures after irrigation of an infected mouse air pouch model to determine whether the suture type influenced the effectiveness of the irrigation. After irrigation of infected pouches, sutures were compared for (1) bacterial adherence and bacterial retention; (2) qualitative and quantitative pouch thickness and cellular density; and (3) quantitative biofilm formation.Methods: Soft tissue air pouches were created on the backs of 60 female, mature 10-week-old BALB/cJ mice by sequentially introducing air into the subcutaneous tissue and allowing the pouch to mature. The pouches were inoculated with Staphylococcus aureus and braided or barbed monofilament sutures were implanted. Pouch irrigation was performed Day 7 after suture implantation. Suture segments were collected before and after irrigation. After euthanasia on Day 14, pouch tissues with residual suture segments were collected for analysis: microbiologic analysis done using optical density as a measure of the concentration of bacteria in the culture (the larger concentration indicates higher number of bacteria) and histologic evaluation of the pouch tissues were semiquantitative, whereas environmental scanning electron microscopy (ESEM) and confocal analyses of the biofilm and bacteria on the sutures were qualitative.Results: Histologic evaluation of pouch tissue showed all groups had inflammatory responses. Quantitatively microbiology showed no difference in bacterial number calculated from the optical density (OD) values between the two suture materials at any time point in the irrigation group. In the no-irrigation group, for the Day 7 time point, mean (± SD) OD was greater in the barbed than the OD in the braided sutures (0.52 ± 0.12 versus 0.37 ± 0.16, mean difference 0.43 [95% confidence interval, 0.08-0.13]; p = 0.007). Qualitatively, ESEM showed more bacterial retention by braided sutures before and after irrigation. Confocal imaging of the sutures demonstrated penetration of biofilm into the interstices of braided sutures and less adhesion in barbed monofilament sutures. The quantification of the biomass showed no differences between groups at all time points (before-irrigation biomass was 11.2 ± 9.3 for braided versus 5.2 ± 4.7 for barbed sutures, p = 0.196; and after-irrigation biomass was 7.2 ± 7.5 for braided versus 3.3 ± 4.3 for barbed suture, p = 0.259).Conclusions: All sutures can retain bacteria and biofilm, but it is rarely possible to remove all suture material at the time of irrigation to treat infection. After an irrigation procedure, qualitatively braided sutures appeared to harbor more bacteria and to retain more biofilm than barbed monofilaments.Clinical Relevance: When saline irrigation was used to simulate infection treatment in an infected mouse air pouch model, bacteria/biofilm was not completely eliminated from either braided or barbed monofilament sutures. The irrigation appeared to clear more bacteria and biofilm from the monofilament despite having barbs. Unfortunately, current technologies do not allow direct quantitative comparisons of biofilm retention. Clinicians should be aware that in the face of infection, any retained sutures may harbor bacteria despite irrigation. [ABSTRACT FROM AUTHOR]

The bacterium Staphylococcus aureus is responsible for significant morbidity, mortality, and financial burden in healthcare. It easily colonizes susceptible patients and can cause recurrent infections, especially in populations at risk. In addition to treating sequelae of infections, there is a growing body of literature aimed at decolonizing susceptible patients in order to prevent infection and also to prevent spread. Such strategies are widely employed in surgical, intensive care, and hospitalist fields. Staphylococcus aureus involvement has been implicated in the pathogenesis and persistence of many dermatologic diseases that are treated in the outpatient setting. This review serves to summarize current evidence for the management of Staphylococcus aureus colonized patients, as well as the evidence available for decolonization. We further characterize the role that colonization may play in atopic dermatitis, recurrent infections, hand eczema, cutaneous T-cell lymphoma, and also in surgical infections after Mohs surgery. [ABSTRACT FROM AUTHOR]

Coagulase-negative Staphylococcus (CoNS) represents one of the major nosocomial pathogen in multimorbid, immunosuppressed patients, especially with device-associated infections, often presenting with a diagnostic dilemma and aggressive antibiotic resistance. We report a case of a healthy young man with no comorbidities who succumbed to an extensive abdominal infection with Staphylococcus epidermidis and Staphylococcus schleiferi after an uneventful diagnostic procedure, despite aggressive antibiotic therapy and surgical source control. Early identification, diagnosis, and aggressive management of CoNS species is warranted depending on clinical scenario and should not be viewed as mere skin contaminants or physiological colonization. [ABSTRACT FROM AUTHOR]

Staphylococcus aureus is a bacterium commonly found on human skin and in the upper respiratory tract. Although it is usually harmless, some strains of Staphylococcus aureus produce a toxin known as Panton-Valentine Leukocidin (PVL) that can cause mild to severe health effects. If PVL is identified, public health action is recommended to prevent transmission. Health protection and primary care teams should work together to carry out a risk assessment and take appropriate action. [ABSTRACT FROM AUTHOR]

Background Despite substantial attention to the individual topics, little is known about the relationship between racial disparities and antimicrobial-resistant and/or healthcare-associated infection trends, such as for methicillin-resistant Staphylococcus aureus (MRSA). Methods We analyzed Emerging Infections Program 2005–2014 surveillance data (9 US states) to determine whether reductions in invasive MRSA incidence (isolated from normally sterile body sites) affected racial disparities in rates. Case classification included hospital-onset (HO, culture >3 days after admission), healthcare-associated community onset (HACO, culture ≤3 days after admission and dialysis, hospitalization, surgery, or long-term care residence within 1 year prior), or community-associated (CA, all others). Negative binomial regression models were used to evaluate the adjusted rate ratio (aRR) of MRSA in black patients (vs in white patients) controlling for age, sex, and temporal trends. Results During 2005–2014, invasive HO and HACO (but not CA) MRSA rates decreased. Despite this, blacks had higher rates for HO (aRR, 3.20; 95% confidence interval [CI], 2.35–4.35), HACO (aRR, 3.84; 95% CI, 2.94–5.01), and CA (aRR, 2.78; 95% CI, 2.30–3.37) MRSA. Limiting the analysis to chronic dialysis patients reduced, but did not eliminate, the higher HACO MRSA rates among blacks (aRR, 1.83; 95% CI, 1.72–1.96), even though invasive MRSA rates among dialysis patients decreased during 2005–2014. These racial differences did not change over time. Conclusions Previous reductions in healthcare-associated MRSA infections have not affected racial disparities in MRSA rates. Improved understanding of the underlying causes of these differences is needed to develop effective prevention interventions that reduce racial disparities in MRSA infections. [ABSTRACT FROM AUTHOR]

Abstract Appropriate therapeutic solutions against Staphylococcal infections are currently limited. To work out the complex task of challenging drug resistance in Staphylococcus aureus , new compounds with novel modes of action are required. In this study, we performed target-driven virtual screening to filter exhaustive phytochemical libraries that can inhibit the activity of S. aureus DNA Gyrase B (Gyr B). Three top-ranked hit molecules (Mangostenone E, Candenatenin A and 2,4,4′-trihydroxydihydrochalcone) were identified from comprehensive molecular docking studies based on their strong spatial affinity with key catalytic residues of the binding pocket of DNA GyrB, especially with the well-known crucial residue Asp81. Molecular dynamics (MD) simulations were performed for these identified hit molecules for better understanding of their dynamical and structural profiles throughout the MD simulations. These compounds can be explored as future lead optimization molecules to discover a new class of antibiotics against resistant Staphylococcus aureus strains. Graphical abstract Image 1 Highlights • Target-driven screening was applied for phytochemical libraries that can inhibit the activity of S. aureus DNA Gyr. B. • Three top-ranked hit molecules (Mangostenone E, Candenatenin A and 2,4,4′-trihydroxydihydrochalcone) were identified. • MD simulations were performed for these hits for better understanding of their dynamical profiles. [ABSTRACT FROM AUTHOR]

Methicillin-resistant Staphylococcus aureus (MRSA) biofilm infections are difficult to treat due to the high antimicrobial resistance of biofilm. Therefore, new treatments are needed for more effective bacteria clearance. This study was to investigate whether low frequency ultrasound (LFU) can enhance the activity of antimicrobial agents against MRSA biofilm infection. Broth microdilution method was used to determine the minimum inhibitory concentration (MIC) of vancomycin (VAN), linezolid (LIN), and levofloxacin (LEV) against three clinical isolated strains, including one methicillin-susceptible Staphylococcus aureus (MSSA) strain and two MRSA strains. Effects of various influencing factors, such as antimicrobial agents, drug concentrations, ultrasonic intensity, and single (S-LFU, 5 or 15 min) or multiple ultrasound (M-LFU, 5 min every 8 h), on the inhibition of biofilms were investigated. The bactericidal effects of S-LFU or M-LFU on MRSA or MSSA biofilms were determined by colony counts. Right after ultrasound, synergistic effects were observed in groups of S-LFU combined with three antimicrobial agents against MSSA biofilm, but for MRSA biofilm, only S-LFU plus VAN had synergistic effect. At the time point of 24 h, M-LFU plus VAN treatment had synergistic bactericidal effect against MRSA and MSSA biofilms, and the synergy showed that VAN is concentration-dependent, but no synergistic effects were observed in all S-LFU combination groups. In conclusion, combination of M-LFU and antimicrobial agents had a better synergistic effect than S-LFU against MRSA or MSSA biofilm. LFU may be useful in treating biofilm infection in the future. [ABSTRACT FROM AUTHOR]

Purpose: Although community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) infections have reduced among inpatient populations, the incidence in athletics continues to range greatly dependent on the sport. Over the 2015 to 2016 and 2016 to 2017 school years, we assessed the annual CA-MRSA incidence, sport risk, referral practices, and management protocols or interventions among high school and intercollegiate athletics. Methods: This study targeted high school and intercollegiate athletic programs across the United States. For the 2015 to 2016 study, 269 athletic trainers completed a one-time questionnaire. In the 2016 to 2017 study, 217 athletic trainers reported data bimonthly during the academic year. Each questionnaire targeted demographic information, physician-confirmed CA-MRSA infection occurrence, and management of CA-MRSA infections and bacterial skin lesions. Results: The CA-MRSA infection incidence was 26.8 per 10,000 athletes (95% confidence interval [CI], 24–30) in 2015–2016 and 20.3 per 10,000 athletes (95% CI, 18–23) in 2016–2017. The CA-MRSA infection incidence was high in wrestling and football compared to the general student-athlete population. During the 2015 to 2016 study, the wrestling incidence rate was 248.3 per 10,000 (95% CI, 204–302); the football incidence rate was 71.0 per 10,000 (95% CI, 60–85). In the 2016 to 2017 study, the wrestling incidence rate was 100.0 per 10,000 (95% CI, 66–151); the football incidence rate was 81.8 per 10,000 (95% CI, 68–99). At least 23% of respondents denoted at least one physician-confirmed CA-MRSA infection within their populations (2015–2016, 39%, n = 105; 2016–2017, 23.5%, n = 51). In the 2015 to 2016 survey, respondents indicated that athlete education and environmental decontamination were the most used management steps (51.8%, n = 582). Conclusions: Despite increased awareness of CA-MRSA, more educational efforts focusing on best practices and education are needed, especially with athletes and the medical community involved in their care. [ABSTRACT FROM AUTHOR]

Introduction: Increasing microbial resistance to antibiotics is one of the main contributors for replacing the appropriate compounds to treat microbial infections. Staphylococcus is one of the most important genera of the bacteria as some strains present on the skin as normal flora and opportunistic infectious agents. Common resistance to antibiotics has been observed in infections caused by this genus from bacteria. Plants have different chemical compounds with antimicrobial properties. The aim of this study was to evaluate the effect of antimicrobial activity of hydroxytyrosol, hydroxytyrosol acetate and hydroxytyrosol oleate which are derived from the leaves of the olive on S. epidermidis and S. aureus. Methods: Hydroxytyrosol, hydroxytyrosol acetate and hydroxytyrosol oleate that are two lipophilic derivatives of hydroxytyrosol, which have been prepared at Magna Graecia University, Italy. The antibiogram test was carried out according to the CLSI guidelines and the Kirby-Bauer method using well assay and Microplate broth dilution for S. aureus and S. epidermidis. Results: The highest Zone of inhibition for the HT, HTA and HTO compounds for Staphylococcus aureus was 30, 19 and 15 mm at a concentration of 100 mg/ml respectively. The highest Zone of inhibition for the HT, HTA and HTO compounds for Staphylococcus epidermidis was 25, 19 and 14 mm at a concentration of 100 mg/ml respectively. The MIC for the above compounds for Staphylococcus aureus was 3.125, 12.5 and 25 mg/ml respectively. The MIC for the above compounds for Staphylococcus epidermidis was 6.25, 12.5 and 50 mg/ml respectively. Conclusion: Respectively, the highest antimicrobial activity against S. aureus and S. epidermidis was evaluated in hydroxytyrosol, hydroxytyrosol acetate and hydroxytyrosol oleate compounds. [ABSTRACT FROM AUTHOR]

Aims: The objective of this study was to determine the effectiveness and safety of cefazolin vs. antistaphylococcal penicillin (ASP) in the treatment of methicillin‐sensitive Staphylococcus aureus (MSSA) bacteraemia. Methods: The databases of PubMed, Embase and Cochrane Central were used to identify comparative trials of cefazolin vs. ASP in MSSA bacteraemia. Meta‐analysis of included trials was performed to assess any differences regarding mortality, clinical cure, recurrence and withdrawal from adverse effects between groups. Data were analysed using fixed effect model. Studies were weighted using Mantel–Haenszel methodology. Heterogeneity was calculated using the I2 statistic. Results: Nine retrospective and one prospective trials were identified involving 4728 patients, 2954 with ASP and 1774 with cefazolin. Meta‐analysis showed a lower mortality rate with cefazolin vs. ASP using fixed effect model [risk ratio (RR) 0.78, 95% confidence interval (CI) 0.69–0.88, P < 0.0001] with borderline high heterogeneity (I2 = 51%). Clinical cure was noted more often with cefazolin (RR 1.09, 95% CI 1.02–1.17, P = 0.02), although no difference was noted with relapse (RR 1.29, 95% CI 0.96–1.74 P = 0.09). Analysis also showed more withdrawals from adverse events with ASP vs. cefazolin (RR 0.27, 95% CI 0.16–0.47, P < 0.00001). A minority of patients enrolled in these trials were admitted to the intensive care unit or had endocarditis (11.4% with ASP and 9% with cefazolin). Conclusion: Our meta‐analysis of retrospective data demonstrate that cefazolin is more effective and safer ASP in patients with MSSA bacteraemia from various causes. Low quality of trials, borderline high heterogeneity, and possible publication bias may limit the validity of our findings. Randomized trials are needed to confirm these findings. [ABSTRACT FROM AUTHOR]

A series of N -sulfonaminoethyloxime derivatives of dehydroabietic acid were synthesized and investigated for their antibacterial activity against Staphylococcus aureus Newman strain and multidrug-resistant strains (NRS-1, NRS-70, NRS-100, NRS-108 and NRS-271). Most of the target compounds having chloro, bromo, trifluoromethyl phenyl moiety exhibited potent in vitro antistaphylococcal activity. The meta -CF 3 phenyl derivative T23 showed the highest activity with MIC of 0.39–0.78 μg/mL against S. aureus Newman, while several analogues showed similar potent antibacterial activity with MIC values between 0.78 and 1.56 μg/mL against five multidrug-resistant S. aureus . The stability of T35 in plasma of SD rat and the cellular cytotoxicity were also evaluated. [ABSTRACT FROM AUTHOR]

Combinations of linezolid (LZD) or trimethoprim/sulfamethoxazole (SXT) plus rifampicin (RIF) are alternative oral treatments for staphylococcal prosthetic joint infections (PJIs) when fluoroquinolones are not possible to use, but there is limited evidence regarding their activity. This study evaluated the efficacy of LZD and SXT, alone and in combination with RIF, against Staphylococcus aureus in an in vitro pharmacokinetic/pharmacodynamic biofilm model. Using the CDC Biofilm Reactor ® system, simulated regimens of LZD (600 mg every 12 h), SXT (160/800 mg every 8 h) and levofloxacin (LVX) (750 mg/day), alone and in combination with RIF (600 mg/day), were evaluated against one methicillin-susceptible S. aureus (MSSA) and one methicillin-resistant S. aureus (MRSA) strain. Antibiotic efficacy was evaluated by the decrease in planktonic bacterial counts from medium and biofilm-embedded bacteria from coupons over 56 h. Resistant strains were screened. In both strains, SXT alone was ineffective and LZD presented low activity, but no resistance emerged. Combinations with RIF significantly increased the antibiofilm efficacy against MSSA (Δlog CFU/mL 56h–0h: SXT + RIF, −2.9 and LZD + RIF, −3.1), but RIF-resistant strains appeared with SXT + RIF. Against MRSA, LZD + RIF (−3.1) protected against the emergence of resistance and was more effective than SXT + RIF (−0.6; P  <   0.05), in which RIF-resistant strains were again detected. LVX + RIF confirmed its high efficacy against biofilm-embedded bacteria, this being the most effective therapy (−5.1 against MSSA). The emergence of RIF-resistant strains with SXT + RIF poses serious concerns for its use in clinical practice. Interestingly, LZD + RIF appears to be an appropriate alternative for PJI caused by LVX-resistant S. aureus . [ABSTRACT FROM AUTHOR]

Objectives: To investigate an outbreak of linezolid-resistant Staphylococcus epidermidis (LRSE) in an interdisciplinary ICU, linezolid consumption and infection control measures taken.Methods: Routine surveillance of nosocomial infections revealed colonization and infection with LRSE affecting 14 patients during a 15 month period. LRSE isolates were analysed with respect to their clonal relatedness, antimicrobial susceptibility, the presence of cfr and/or mutations in the 23S rRNA, rplC, rplD and rplV genes. cfr plasmids were characterized by Illumina sequencing. Medical records were reviewed and antibiotic consumption was determined.Results: Molecular typing identified the presence of three different LRSE clusters: PFGE type I/ST168 (n = 5), PFGE type II/ST5 (n = 10) and PFGE type III/ST2 (n = 1). Ten strains harboured the cfr gene; we also detected mutations in the respective ribosomal protein genes. WGS revealed an almost identical 39 kb cfr plasmid obtained from strains of different genetic background (ST2, ST5, ST168) that shows high similarity to the recently published LRSE plasmid p12-02300. Due to an increase in the number of patients treated for infections with MRSA, a significant increase in linezolid usage was noted from January to July 2014 (from 5.55 to 20.41 DDDs/100 patient-days).Conclusions: Here, we report the molecular epidemiology of LRSE in an ICU. Our results suggest the selection of resistant mutants under linezolid treatment as well as the spread of cfr-carrying plasmids. The reduction of linezolid usage and the strengthening of contact precautions proved to be effective infection control measures. [ABSTRACT FROM AUTHOR]

Background: Irrigation is one of the key procedures in open fracture management to eliminate pathogens and prevent infection. Metal ion deprivation could inhibit bacterial adhesins and weaken adhesion to the host tissue. EDTA in solution can competitively bind to a metal ion and thus might be able to inhibit bacterial adhesins.Questions/purposes: (1) Is normal saline-EDTA toxic to fibroblasts and endothelial cells? (2) In a contaminated wound rat model, does irrigation with normal saline-EDTA solution decrease the risk of positive bacterial cultures and infection when compared with normal saline and soap solutions? (3) In an infected wound rat model, are fewer surgical débridements and irrigations with normal saline-EDTA solution required to obtain culture-free wounds when compared with normal saline and soap controls?Methods: Normal saline-EDTA solution refers to 1 mmol/L EDTA dissolved in normal saline (pH adjusted to 7.4). Normal saline and soap solutions acted as controls. The toxicity of these solutions to fibroblasts and endothelial cells was assessed in vitro by Annexin V/propidium iodide staining and flow cytometer counting (a well-established method to quantitatively measure the number of dead cells). We established contaminated and infected wound models (bone-exposed or not) with either Staphylococcus aureus or Escherichia coli in rats to investigate the efficacy of normal saline-EDTA solution (n = 30 for the contaminated model and n = 50 for the infected model). For contaminated wounds, the proportion of positive bacterial cultures and infections was compared after irrigation and débridement among the three groups. For infected wounds, we performed irrigation and débridement every 48 hours until the cultures were negative and compared the number of débridements required to achieve a negative culture with survival analysis.Results: Normal saline-EDTA showed no additional toxicity to fibroblasts and endothelial cells when compared with normal saline (normal saline [97%] versus EDTA [98%] on fibroblasts, p = 0.654; normal saline [97%] versus EDTA [98%] on endothelial cells, p = 0.711). When bone was exposed in the contaminated models, EDTA irrigation resulted in fewer positive bacterial cultures with S aureus (EDTA: 23%, normal saline: 67%, soap: 40%, p = 0.003) and with E coli (EDTA: 27%, normal saline: 57%, soap: 30%, p = 0.032); however, infection risk was only lower with EDTA irrigation (S aureus with EDTA: 10%, normal saline: 33%, soap: 37%, p = 0.039; E coli with EDTA: 3%, normal saline: 27%, soap: 23%, p = 0.038). In the infected wound model, EDTA irrigation resulted in earlier culture-negative wounds (fewer surgical sessions) compared with normal saline and soap solutions (nonbone-exposed wounds infected by S aureus: p = 0.003, infected by E coli: p = 0.001; bone-exposed wounds infected by S aureus: p = 0.012, infected by E coli: p = 0.022).Conclusions: After in vitro assessment of toxicity and in vivo evaluation of efficacy, we concluded that normal saline-EDTA is superior to normal saline and soap solution in our laboratory models.Clinical Relevance: The use of normal-saline EDTA as an irrigation solution may reduce the infection rate of wounds. Future studies in large animals and humans might prove our observation in rat models that normal saline-EDTA has an advantage over normal saline as an irrigation solution. [ABSTRACT FROM AUTHOR]

Antibiotic therapy of staphylococcal mastitis is characterized by significantly lower cure rates compared to infections caused by other microorganisms. Thus, it is necessary to search for new, alternative, non-antibiotic agents that are effective in the eradication of these bacteria. The aim of our research was to investigate the antimicrobial, especially anti-staphylococcal potential of a large collection (n=36) of essential oils (EOs). Investigation of the antimicrobial activity of tested oils was determined by using a serial, twofold dilution method in 96-wells microtiter plates under conditions recommended by the Clinical and Laboratory Standards Institute (CLSI). The preliminary analysis revealed that six oils, namely: Manuka, Thyme, Geranium, Cedar, Cinnamon (from bark) and Patchouli exhibited the highest activity against reference strains of bacteria. Significant anti-staphylococcal potential of these oils has been also confirmed for a group of 18 Staphylococcus aureus, 8 Staphylococcus epidermidis and 5 Staphylococcus xylosus strains isolated from cases of bovine mastitis. Especially high activity was observed for Cedar, Patchouli, Thyme and Manuka oils. The MIC (Minimal Inhibitory Concentration) values for Patchouli oil were in the concentrations range of 0.01 to 0.313% (v/v). The three other oils inhibited the growth of staphylococci isolated from mastitis in the concentrations range of 0.01 to 0.625% (v/v). Oils isolated from Cinnamomum cassia and Pelargonium graveolens revealed a bit lower, but still satisfactory activity (MIC values in the concentrations range of 0.02 to 1.25% (v/v) and from 0.078 to 1.25% (v/v), respectively). In many cases a slightly higher concentration of oils was required to obtain the bactericidal effect in comparison to growth inhibition. The time -- kill kinetic assay revealed that the bactericidal effect was achieved after two hours incubation of the reference strain S. aureus PCM 2051 cells with Thyme oil at concentration equal to 2xMIC (1.25% (v/v)) or MIC (0.625% (v/v)). A slightly lower activity was observed in the case of Cinnamon oil, the bactericidal effect was achieved after 8 hours of incubation. The results of our research clearly indicate that some essential oils exhibit a promising antimicrobial activity and can be considered as alternative antistaphylococcal agents. [ABSTRACT FROM AUTHOR]

The synthesis of the aglycon of disciformycin, a new secondary metabolite from Pyxidicoccus fallax, is reported. The disciformycins are highly potent antibiotics including inhibitory activity towards methicillin- and vancomycin-resistant Staphylo-coccus aureus. The stereocontrolled installation of the olefinic double bonds at C2-C3/C3-C4 and C12-C13, respectively, as well as the orthogonal differentiation of the oxy functionalities turned out to be key challenges of our approach. [ABSTRACT FROM AUTHOR]

Though there is an abundance of information on cutaneous malignancies in transplant recipients, cutaneous infections in solid organ transplant recipients (SOTRs) are underrepresented in the dermatological literature. Our paper provides a comprehensive review of bacterial cutaneous infections within the solid organ transplant population. Cutaneous bacterial infections may lead to significant morbidity and even mortality in this immunosuppressed population. Thus, it is to the benefit of both dermatologists and other transplant care providers to better understand and recognize the features of cutaneous bacterial infections in SOTRs. This paper can aid providers in promptly identifying, diagnosing, and treating bacterial skin infections. This review discusses the diagnosis and treatment of the following bacterial species: Staphylococcus, Streptococcus, Pseudomonas aeruginosa, Escherichia coli, Nocardia, Mycobacteria, and Bartonella henselae. [ABSTRACT FROM AUTHOR]

Background: Purulent pericarditis is an uncommon entity, which is, in very rare cases, associated to infection of the aorta.Case Presentation: We present the case of a 42-year-old male patient, who was admitted to hospital complaining of tiredness, diarrhea and leg edema. Clinical examination revealed a hypotensive and obviously shocked patient. He was ultimately diagnosed with a rare combination of purulent pericarditis followed by false aneurysm of the ascending aorta. He was successfully treated by surgical pericardial drainage, replacement of the ascending aorta and antibiotics.Conclusion: Mycotic aneurysms can rarely be associated with purulent pericarditis. Our literature review shows that there are two mechanisms explaining this association and that in most of the published cases infective endocarditis could not be demonstrated. [ABSTRACT FROM AUTHOR]