91 results on '"Perdreau-Remington F"'
Search Results
2. A four-year prospective study on microbial ecology of explanted prosthetic hips in 52 patients with “aseptic” prosthetic joint loosening
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Perdreau-Remington, F., Stefanik, D., Peters, G., Ludwig, C., Riitt, J., Wenzel, R., and Pulverer, G.
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- 1996
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3. Molecular characterisation of MRSA by spa-typing, MLST and PFGE in the Cologne metropolitan area from 1984 to 1998: P997
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Wisplinghoff, H., Wisplinghoff, S., Ewertz, B., Stefanik, D., Perdreau-Remington, F., and Seifert, H.
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- 2005
4. Increased community-onset MRSA disease prevalence due to MRSA clones colonising the nares of healthy individuals in the community
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Diep, B. A., Carleton, H., Pan, E., Sensabaugh, G., and Perdreau-Remington, F.
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- 2004
5. Panton-Valentine leukocidin associated epidemic of soft tissue infections in the San Francisco community
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Diep, B. A., Sensabaugh, G. F., Somboona, N., Carleton, H., and Perdreau-Remington, F.
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- 2003
6. Slime production of Staphylococcus epidermidis: increased bacterial adherence and accumulation onto pure titanium
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J. Rütt, Perdreau-Remington F, D. P. König, Stossberger P, Ralf-Dieter Hilgers, and Plum G
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Micrococcaceae ,Prosthesis-Related Infections ,Time Factors ,Mutant ,Colony Count, Microbial ,Drug Evaluation, Preclinical ,chemistry.chemical_element ,Bacterial Adhesion ,Microbiology ,Incubation period ,Staphylococcus epidermidis ,Humans ,Orthopedics and Sports Medicine ,Serotyping ,Titanium ,Analysis of Variance ,biology ,Strain (chemistry) ,fungi ,Temperature ,biochemical phenomena, metabolism, and nutrition ,equipment and supplies ,biology.organism_classification ,In vitro ,carbohydrates (lipids) ,chemistry ,Biofilms ,bacteria ,Surgery ,Bacteria - Abstract
In an in vitro study using Staphylococcus epidermidis RP 62 A, a slime-producing strain and its isogenic slime-negative mutant M7, we demonstrated that both strains adhere to pure titanium discs with significantly higher colony counts for the slime-producing strain. The colony count was dependent on temperature, time and strain. Prolonged incubation time (24 h) under growth conditions leads to higher colony counts for the slime-producing strain RP 62 A. As the slime-negative mutant M 7 can adhere to, but not form multiple layers on metallic surfaces, increase of incubation time does not produce higher colony counts on the metallic surface. We conclude that slime production is important for adherence and subsequent accumulation of S. epidermidis onto pure titanium discs in vitro.
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- 1998
7. Identifying multiple isolates through the comparison of genomic DNAs in a patient with infected hip prosthesis
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Perdreau-Remington, F, Rank, D R, Lopez, F A, and Goodmann, S B
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DNA, Bacterial ,Genome ,Prosthesis-Related Infections ,Staphylococcus epidermidis ,Humans ,Female ,Hip Prosthesis ,Staphylococcal Infections ,Polymorphism, Restriction Fragment Length ,Research Article ,Aged ,Electrophoresis, Gel, Pulsed-Field - Published
- 1998
8. Concurrent Epidemics of Skin and Soft Tissue Infection and Bloodstream Infection Due to Community-Associated Methicillin-Resistant Staphylococcus aureus
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Tattevin, P., primary, Schwartz, B. S., additional, Graber, C. J., additional, Volinski, J., additional, Bhukhen, A., additional, Mai, T. T., additional, Vo, N. H., additional, Dang, D. N., additional, Phan, T. H., additional, Basuino, L., additional, Perdreau-Remington, F., additional, Chambers, H. F., additional, and Diep, B. A., additional
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- 2012
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9. In Vitro Production of Panton-Valentine Leukocidin among Strains of Methicillin-Resistant Staphylococcus aureus Causing Diverse Infections
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Hamilton, S. M., primary, Bryant, A. E., additional, Carroll, K. C., additional, Lockary, V., additional, Ma, Y., additional, McIndoo, E., additional, Miller, L. G., additional, Perdreau-Remington, F., additional, Pullman, J., additional, Risi, G. F., additional, Salmi, D. B., additional, and Stevens, D. L., additional
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- 2007
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10. P2090 In vitro activity of API-1252, a novel antistaphylococcal agent, against 100 genotypically unique Staphylococcus aureus strains
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Perdreau-Remington, F., primary, Zhanel, G., additional, Vaughan, D., additional, and Kaplan, N., additional
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- 2007
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11. Origins of Community Strains of Methicillin-Resistant Staphylococcus aureus
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Charlebois, E. D., primary, Perdreau-Remington, F., additional, Kreiswirth, B., additional, Bangsberg, D. R., additional, Ciccarone, D., additional, Diep, B. A., additional, Ng, V. L., additional, Chansky, K., additional, Edlin, B., additional, and Chambers, H. F., additional
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- 2004
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12. Population-Based Community Prevalence of Methicillin-Resistant Staphylococcus aureus in the Urban Poor of San Francisco
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Charlebois, E. D., primary, Bangsberg, D. R., additional, Moss, N. J., additional, Moore, M. R., additional, Moss, A. R., additional, Chambers, H. F., additional, and Perdreau-Remington, F., additional
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- 2002
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13. A 140-kilodalton extracellular protein is essential for the accumulation of Staphylococcus epidermidis strains on surfaces
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Hussain, M, primary, Herrmann, M, additional, von Eiff, C, additional, Perdreau-Remington, F, additional, and Peters, G, additional
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- 1997
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14. In-vitro Activity of Penicillin G plus Sulbactam in Comparison with other ß-lactamase Inhibitor Combinations and Oxacillin against Staphylococci
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Jansen, Bernd, primary, Perdreau-Remington, F., additional, and Pulverer, G., additional
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- 1996
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15. Characterization of Tn917 insertion mutants of Staphylococcus epidermidis affected in biofilm formation
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Heilmann, C, primary, Gerke, C, additional, Perdreau-Remington, F, additional, and Götz, F, additional
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- 1996
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16. Methicillin-resistant Staphylococcus haemolyticus on the hands of health care workers: a route of transmission or a source?
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Perdreau-Remington, F., primary, Stefanik, D., additional, Peters, G., additional, Ruckdeschel, G., additional, Haas, F., additional, Wenzel, R., additional, and Pulverer, G., additional
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- 1995
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17. Population dynamics of nasal strains of methicillin-resistant Staphylococcus aureus -- and their relation to community-associated disease activity.
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Pan ES, Diep BA, Charlebois ED, Auerswald C, Carleton HA, Sensabaugh GF, and Perdreau-Remington F
- Abstract
BACKGROUND: Nasal carriage of methicillin-resistant Staphylococcus aureus (MRSA) plays a key role in the epidemiology and pathogenesis of disease. The purpose of this study was to determine the characteristics and dynamics of nasal strains of MRSA, as well as their relation to community-associated disease activity. METHODS: This study is a cross-sectional survey and molecular epidemiologic analysis of nasal colonization by S. aureus in homeless and runaway youths, an underserved population at high risk for staphylococcal disease. RESULTS: Of the 308 study participants, 27.6% carried S. aureus, and 6.2% carried MRSA. Subgroups of individuals with increased MRSA carriage rates were also at highest risk for community-associated MRSA infection; these subgroups included individuals with either HIV infection or AIDS, injection drug users, patients with abscesses, and those recently hospitalized. Multilocus sequence typing and pulsed-field gel electrophoresis identified 2 genotypes--ST59:P (USA1000) and ST8:S (USA300)--that accounted for 84.2% (16/19) of the MRSA isolates carried. The genotypes were distinct from nosocomial genotypes endemic in the hospital, although they originated from individuals with prior exposure to health care. CONCLUSIONS: Comparison of MRSA strains from asymptomatic carriers versus concurrently collected community-associated clinical strains from patients treated at local health-care facilities allowed for the identification of 3 population dynamics of nasal strains of MRSA: (1) endemic clones--for example, ST8:C and ST59:P--sustained asymptomatic carriage and infection over prolonged periods; (2) an epidemic clone, ST8:S, demonstrated enhanced capacity for rapid transmission and widespread infections; and (3) an outbreak clone, ST30:Z (USA1100), was highly infectious but exhibited poor asymptomatic transmission. Copyright © 2005 Infectious Diseases Society of America [ABSTRACT FROM AUTHOR]
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- 2005
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18. Necrotizing fasciitis caused by community-associated methicillin-resistant Staphylococcus aureus in Los Angeles.
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Miller LG, Perdreau-Remington F, Rieg G, Mehdi S, Perlroth J, Bayer AS, Tang AW, Phung TO, and Spellberg B
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- 2005
19. High prevalence of methicillin-resistant Staphylococcus aureus in emergency department skin and soft tissue infections.
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Frazee BW, Lynn J, Charlebois ED, Lambert L, Lowery D, and Perdreau-Remington F
- Abstract
Much of the literature on pulmonary embolism that is commonly referenced by emergency physicians begins with statistics concerning how often the diagnosis is missed and the lethality of pulmonary embolism if undiagnosed and untreated. It is likely that many emergency physicians continue to pursue an aggressive diagnostic strategy even in low-risk patients because of concerns about the potential for poor patient outcome and the medicolegal consequences of a missed diagnosis. The believed and often-quoted mortality and recurrence rates for untreated or missed pulmonary embolism are 26% to 30%. However, these figures originate from investigations that have little relevance to modern emergency medicine, which include studies dating to the 1940s, many of which have significant methodologic pitfalls. These data are also based primarily on either inpatient or autopsy populations, neither of which is representative of patients treated in the emergency department (ED). Analysis of untreated or missed pulmonary embolism in ambulatory patients reveals mortality and recurrence rates of less than 5%. This article discusses the background of commonly quoted pulmonary embolism statistics and highlights the need for future investigations enrolling ED patients that focus on disease outcome in this population. [ABSTRACT FROM AUTHOR]
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- 2005
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20. The abilities of a Staphylococcus epidermidis wild-type strain and its slime-negative mutant to induce endocarditis in rabbits are comparable.
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Perdreau-Remington, F, Sande, M A, Peters, G, and Chambers, H F
- Abstract
The abilities of a parent and mutant pair of Staphylococcus epidermidis strains, the slime-producing parent RP62A and its slime-negative mutant, to establish endocarditis in a rabbit model of aortic valve endocarditis and to accumulate and adhere to surfaces in vitro were compared. Vegetation titer and infection rate depended on the presence or absence of a catheter (P = 0.020) and on inoculum size (P < 0.001) but not on the infecting strain. The ability of the parent strain vis-à-vis its mutant to accumulate in vitro on surfaces as demonstrated in a slime test did not correlate with any enhancement in the development of endocarditis in the rabbit model. In vitro initial adherence rates were identical. Both isolates accumulated to the same reduced extent in vitro in the presence of serum, albumin, or gelatin. Adhesion was equally promoted by addition of fibronectin. These data suggest that the in vitro phenomenon of accumulation described as slime production in the absence of serum may not be an important virulence determinant in vivo.
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- 1998
21. Complete genome sequence of USA300, an epidemic clone of community-acquired meticillin-resistant Staphylococcus aureus.
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Diep BA, Gill SR, Chang RF, Phan TH, Chen JH, Davidson MG, Lin F, Lin J, Carleton HA, Mongodin EF, Sensabaugh GF, and Perdreau-Remington F
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- 2006
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22. MRSA in the community.
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Chapman ALN, Greig JM, Innes JA, Hageman JC, Lynfield R, Fridkin SK, Miller LG, Perdreau-Remington F, and Spellberg B
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- 2005
23. Clonal composition and community clustering of drug-susceptible and -resistant Escherichia coli isolates from bloodstream infections.
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Adams-Sapper S, Diep BA, Perdreau-Remington F, and Riley LW
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- Adhesins, Escherichia coli classification, Bacteremia microbiology, Clone Cells, Community-Acquired Infections microbiology, Drug Resistance, Bacterial genetics, Escherichia coli classification, Escherichia coli isolation & purification, Escherichia coli Infections microbiology, Fimbriae Proteins classification, Humans, Microbial Sensitivity Tests, Multilocus Sequence Typing, Polymorphism, Single Nucleotide, Adhesins, Escherichia coli genetics, Anti-Bacterial Agents pharmacology, Bacteremia drug therapy, Community-Acquired Infections drug therapy, Escherichia coli drug effects, Escherichia coli genetics, Escherichia coli Infections drug therapy, Fimbriae Proteins genetics
- Abstract
Multidrug-resistant Escherichia coli strains belonging to a single lineage frequently account for a large proportion of extraintestinal E. coli infections in many parts of the world. However, limited information exists on the community prevalence and clonal composition of drug-susceptible E. coli strains. Between July 2007 and September 2010, we analyzed all consecutively collected Gram-negative bacterial isolates from patients with bloodstream infection (BSI) admitted to a public hospital in San Francisco for drug susceptibility and associated drug resistance genes. The E. coli isolates were genotyped for fimH single nucleotide polymorphisms (SNPs) and multilocus sequence types (MLSTs). Among 539 isolates, E. coli accounted for 249 (46%); 74 (30%) of them were susceptible to all tested drugs, and 129 (52%) were multidrug resistant (MDR). Only five MLST genotypes accounted for two-thirds of the E. coli isolates; the most common were ST131 (23%) and ST95 (18%). Forty-seven (92%) of 51 ST131 isolates, as opposed to only 8 (20%) of 40 ST95 isolates, were MDR (P < 0.0001). The Simpson's diversity index for drug-susceptible ST genotypes was 87%, while the index for MDR ST genotypes was 81%. ST95 strains were comprised of four fimH types, and one of these (f-6) accounted for 67% of the 21 susceptible isolates (P < 0.003). A large proportion (>70%) of both MDR and susceptible E. coli BSI isolates represented community-onset infections. These observations show that factors other than the selective pressures of antimicrobial agents used in hospitals contribute to community-onset extraintestinal infections caused by clonal groups of E. coli regardless of their drug resistance.
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- 2013
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24. Multicenter evaluation of the LightCycler MRSA advanced test, the Xpert MRSA Assay, and MRSASelect directly plated culture with simulated workflow comparison for the detection of methicillin-resistant Staphylococcus aureus in nasal swabs.
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Arcenas RC, Spadoni S, Mohammad A, Kiechle FL, Walker K, Fader RC, Perdreau-Remington F, Osiecki J, Liesenfeld O, Hendrickson S, and Rao A
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- Humans, Workflow, Methicillin-Resistant Staphylococcus aureus pathogenicity, Nose microbiology, Staphylococcal Infections diagnosis
- Abstract
Rapid detection of nasal colonization with methicillin-resistant Staphylococcus aureus (MRSA) followed by appropriate infection control procedures reduces MRSA infection and transmission. We compared the performance and workflow of two Food and Drug Administration-approved nucleic acid amplification assays, the LightCycler MRSA Advanced Test and the Xpert MRSA test, with those of directly plated culture (MRSASelect) using 1202 nasal swabs collected at three U.S. sites. The sensitivity of the LightCycler test (95.2%; 95% CI, 89.1% to 98.4%) and Xpert assay (99%; 95% CI, 94.8% to 100%) did not differ compared with that of culture; the specificity of the two assays was identical (95.5%; 95% CI, 94.1% to 96.7%) compared with culture. However, sequencing performed on 71 samples with discordant results among the three methods confirmed the presence of MRSA in 40% of samples that were positive by both molecular methods but negative by culture. Workflow analysis from all sites including batch runs revealed average hands-on sample preparation times of 1.40, 2.35, and 1.44 minutes per sample for the LightCycler, Xpert, and MRSASelect methods, respectively. Discrete event simulation analysis of workflow efficiencies revealed that the LightCycler test used less hands-on time for the assay when greater than eight batched samples were run. The high sensitivity and specificity, low hands-on time, and efficiency gains using batching capabilities make the LightCycler test suitable for rapid batch screening of MRSA colonization., (Copyright © 2012 American Society for Investigative Pathology and the Association for Molecular Pathology. Published by Elsevier Inc. All rights reserved.)
- Published
- 2012
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25. Genetic diversity of arginine catabolic mobile element in Staphylococcus epidermidis.
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Miragaia M, de Lencastre H, Perdreau-Remington F, Chambers HF, Higashi J, Sullam PM, Lin J, Wong KI, King KA, Otto M, Sensabaugh GF, and Diep BA
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- Cations, Cloning, Molecular, DNA Transposable Elements, Drug Resistance, Microbial, Genes, Bacterial, Genetic Techniques, Genetic Variation, Genotype, Hydrolases genetics, Methicillin-Resistant Staphylococcus aureus genetics, Multigene Family, Polymerase Chain Reaction, Polymorphism, Restriction Fragment Length, Virulence, Staphylococcus epidermidis genetics
- Abstract
Background: The methicillin-resistant Staphylococcus aureus clone USA300 contains a novel mobile genetic element, arginine catabolic mobile element (ACME), that contributes to its enhanced capacity to grow and survive within the host. Although ACME appears to have been transferred into USA300 from S. epidermidis, the genetic diversity of ACME in the latter species remains poorly characterized., Methodology/principal Findings: To assess the prevalence and genetic diversity of ACME, 127 geographically diverse S. epidermidis isolates representing 86 different multilocus sequence types (STs) were characterized. ACME was found in 51% (65/127) of S. epidermidis isolates. The vast majority (57/65) of ACME-containing isolates belonged to the predominant S. epidermidis clonal complex CC2. ACME was often found in association with different allotypes of staphylococcal chromosome cassette mec (SCCmec) which also encodes the recombinase function that facilities mobilization ACME from the S. epidermidis chromosome. Restriction fragment length polymorphism, PCR scanning and DNA sequencing allowed for identification of 39 distinct ACME genetic variants that differ from one another in gene content, thereby revealing a hitherto uncharacterized genetic diversity within ACME. All but one ACME variants were represented by a single S. epidermidis isolate; the singular variant, termed ACME-I.02, was found in 27 isolates, all of which belonged to the CC2 lineage. An evolutionary model constructed based on the eBURST algorithm revealed that ACME-I.02 was acquired at least on 15 different occasions by strains belonging to the CC2 lineage., Conclusions/significance: ACME-I.02 in diverse S. epidermidis isolates were nearly identical in sequence to the prototypical ACME found in USA300 MRSA clone, providing further evidence for the interspecies transfer of ACME from S. epidermidis into USA300.
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- 2009
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26. Methicillin-resistant Staphylococcus aureus USA300 clone in long-term care facility.
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Tattevin P, Diep BA, Jula M, and Perdreau-Remington F
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- Aged, Anti-Bacterial Agents pharmacology, Cross Infection microbiology, Cross Infection transmission, Female, Humans, Male, Methicillin Resistance, Microbial Sensitivity Tests, Middle Aged, San Francisco epidemiology, Skin microbiology, Staphylococcal Skin Infections microbiology, Staphylococcal Skin Infections transmission, Cross Infection epidemiology, Hospitals, Long-Term Care, Methicillin-Resistant Staphylococcus aureus classification, Methicillin-Resistant Staphylococcus aureus drug effects, Methicillin-Resistant Staphylococcus aureus genetics, Methicillin-Resistant Staphylococcus aureus isolation & purification, Staphylococcal Skin Infections epidemiology
- Abstract
We performed a longitudinal analysis of 661 methicillin-resistant Staphylococcus aureus (MRSA) isolates obtained from patients in a long-term care facility. USA300 clone increased from 11.3% of all MRSA isolates in 2002 to 64.0% in 2006 (p<0.0001) and was mostly recovered from skin or skin structures (64.3% vs. 27.0% for non-USA300 MRSA; p<0.0001).
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- 2009
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27. Doxycycline, not minocycline, induces its own resistance in multidrug-resistant, community-associated methicillin-resistant Staphylococcus aureus clone USA300.
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Schwartz BS, Graber CJ, Diep BA, Basuino L, Perdreau-Remington F, and Chambers HF
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- Community-Acquired Infections microbiology, Humans, Methicillin-Resistant Staphylococcus aureus isolation & purification, Microbial Sensitivity Tests, Staphylococcal Infections microbiology, Anti-Bacterial Agents pharmacology, Doxycycline pharmacology, Enzyme Activators pharmacology, Methicillin-Resistant Staphylococcus aureus drug effects, Minocycline pharmacology, Tetracycline Resistance
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- 2009
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28. Phenotypic and genotypic characteristics of persistent methicillin-resistant Staphylococcus aureus bacteremia in vitro and in an experimental endocarditis model.
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Xiong YQ, Fowler VG, Yeaman MR, Perdreau-Remington F, Kreiswirth BN, and Bayer AS
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- Animals, Anti-Bacterial Agents pharmacology, Bacteremia drug therapy, Disease Models, Animal, Endocarditis, Bacterial drug therapy, Genotype, Humans, Methicillin Resistance, Methicillin-Resistant Staphylococcus aureus drug effects, Methicillin-Resistant Staphylococcus aureus isolation & purification, Microbial Sensitivity Tests, Phenotype, Rabbits, Staphylococcal Infections drug therapy, Vancomycin pharmacology, Bacteremia microbiology, Endocarditis, Bacterial microbiology, Methicillin-Resistant Staphylococcus aureus classification, Methicillin-Resistant Staphylococcus aureus genetics, Staphylococcal Infections microbiology
- Abstract
Background: Persistent MRSA bacteremia (PB) represents an important subset of Staphylococcus aureus infections and correlates with poor clinical outcomes., Methods: We profiled relevant in vitro phenotypic and genotypic characteristics of MRSA isolates from 39 persons with bacteremia (21 had PB and 18 had resolving bacteremia [RB]). We also compared the intrinsic virulence and responsiveness to vancomycin of selected PB and RB strains in an experimental endocarditis model (IE)., Results: PB and RB isolates differed significantly with regard to several in vitro characteristics that are believed to impact endovascular infections. PB isolates exhibited significantly more resistance to the cationic defensin hNP-1, enhanced membrane fluidity, and substantially greater adhesion to fibronectin, fibrinogen, and endothelial cells. Genotypically, PB isolates had higher frequency of SCCmec II, CC30, and spa 16; and higher rates of agr type III, cap8, tst-1, and cna carriage. Finally, a prototypic PB strain was more resistant to vancomycin treatment in the infective endocarditis model than a RB comparator strain, despite equivalent virulence profiles., Conclusions: Our findings indicate that PB isolates may have specific virulence signatures that distinguish them from RB isolates. These data suggest that methods might be developed to identify patients at higher risk for PB in real-time, thereby optimizing the effectiveness of anti-MRSA therapeutic strategies.
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- 2009
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29. Long-term follow-up of methicillin-resistant Staphylococcus aureus molecular epidemiology after emergence of clone USA300 in San Francisco jail populations.
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Tattevin P, Diep BA, Jula M, and Perdreau-Remington F
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- Adult, DNA Fingerprinting, Electrophoresis, Gel, Pulsed-Field, Female, Genotype, Humans, Male, Methicillin-Resistant Staphylococcus aureus isolation & purification, Middle Aged, Polymorphism, Restriction Fragment Length, Prisoners, San Francisco epidemiology, DNA, Bacterial genetics, Methicillin-Resistant Staphylococcus aureus classification, Methicillin-Resistant Staphylococcus aureus genetics, Molecular Epidemiology, Staphylococcal Infections epidemiology, Staphylococcal Infections microbiology
- Abstract
We performed a longitudinal analysis of 502 unique methicillin-resistant Staphylococcus aureus (MRSA) clinical isolates originating from San Francisco jail inmates between 2000 and 2007. Strain USA300, first encountered in 2001, accounted for 82.1% (412/502) of MRSA infections. Non-USA300 MRSA strains were rarely found after 2005 (one isolate in 2006, three in 2007).
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- 2008
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30. Recurrence of skin and soft tissue infection caused by methicillin-resistant Staphylococcus aureus in a HIV primary care clinic.
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Graber CJ, Jacobson MA, Perdreau-Remington F, Chambers HF, and Diep BA
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- Adult, Aged, Female, Humans, Male, Middle Aged, Recurrence, Staphylococcus aureus isolation & purification, Cross Infection microbiology, HIV Infections complications, Methicillin Resistance, Soft Tissue Infections microbiology, Staphylococcal Skin Infections microbiology, Staphylococcus aureus drug effects
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- 2008
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31. A population-based study of the incidence and molecular epidemiology of methicillin-resistant Staphylococcus aureus disease in San Francisco, 2004-2005.
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Liu C, Graber CJ, Karr M, Diep BA, Basuino L, Schwartz BS, Enright MC, O'Hanlon SJ, Thomas JC, Perdreau-Remington F, Gordon S, Gunthorpe H, Jacobs R, Jensen P, Leoung G, Rumack JS, and Chambers HF
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- Adult, Community-Acquired Infections microbiology, Female, Humans, Male, Molecular Epidemiology, Population Surveillance, Prospective Studies, San Francisco epidemiology, Staphylococcal Infections transmission, Community-Acquired Infections epidemiology, Methicillin Resistance, Staphylococcal Infections epidemiology, Staphylococcal Infections microbiology, Staphylococcal Skin Infections epidemiology, Staphylococcal Skin Infections microbiology, Staphylococcal Skin Infections physiopathology, Staphylococcus aureus
- Abstract
Background: Methicillin-resistant Staphylococcus aureus (MRSA) infections have become a major public health problem in both the community and hospitals. Few studies have characterized the incidence and clonal composition of disease-causing strains in an entire population. Our objective was to perform a population-based survey of the clinical and molecular epidemiology of MRSA disease in San Francisco, California., Methods: We prospectively collected 3985 MRSA isolates and associated clinical and demographic information over a 12-month period (2004-2005) at 9 San Francisco-area medical centers. A random sample of 801 isolates was selected for molecular analysis., Results: The annual incidence of community-onset MRSA disease among San Francisco residents was 316 cases per 100,000 population, compared with 31 cases per 100,000 population for hospital-onset disease. Persons who were aged 35-44 years, were men, and were black had the highest incidence of community-onset disease. The USA300 MRSA clone accounted for 234 cases of community-onset disease and 15 cases of hospital-onset disease per 100,000 population, constituting an estimated 78.5% and 43.4% of all cases of MRSA disease, respectively. Patients with community-onset USA300 MRSA versus non-USA300 MRSA disease were more likely to be male, be of younger age, and have skin and soft-tissue infections. USA300 strains were generally more susceptible to multiple antibiotics, although decreased susceptibility to tetracycline was observed in both community-onset (P = .008) and hospital-onset (P = .03) USA300 compared to non-USA300 strains., Conclusions: The annual incidence of community-onset MRSA disease in San Francisco is substantial, surpassing that of hospital-onset disease. USA300 is the predominant clone in both the community and hospitals. The dissemination of USA300 from the community into the hospital setting has blurred its distinction as a community-associated pathogen.
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- 2008
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32. The arginine catabolic mobile element and staphylococcal chromosomal cassette mec linkage: convergence of virulence and resistance in the USA300 clone of methicillin-resistant Staphylococcus aureus.
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Diep BA, Stone GG, Basuino L, Graber CJ, Miller A, des Etages SA, Jones A, Palazzolo-Ballance AM, Perdreau-Remington F, Sensabaugh GF, DeLeo FR, and Chambers HF
- Subjects
- Animals, Bacteremia microbiology, Chromosomes, Bacterial, DNA, Bacterial genetics, Electrophoresis, Gel, Pulsed-Field, Genomic Islands, Male, Phylogeny, Rabbits, Sequence Deletion, Staphylococcus aureus genetics, Virulence, Interspersed Repetitive Sequences, Methicillin Resistance, Staphylococcus aureus drug effects, Staphylococcus aureus pathogenicity
- Abstract
The epidemic character of community-associated methicillin-resistant Staphylococcus aureus, especially the geographically widespread clone USA300, is poorly understood. USA300 isolates carry a type IV staphylococcal chromosomal cassette mec (SCCmec) element conferring beta-lactam antibiotic class resistance and a putative pathogenicity island, arginine catabolic mobile element (ACME). Physical linkage between SCCmec and ACME suggests that selection for antibiotic resistance and for pathogenicity may be interconnected. We constructed isogenic mutants containing deletions of SCCmec and ACME in a USA300 clinical isolate to determine the role played by these elements in a rabbit model of bacteremia. We found that deletion of type IV SCCmec did not affect competitive fitness, whereas deletion of ACME significantly attenuated the pathogenicity or fitness of USA300. These data are consistent with a model in which ACME enhances growth and survival of USA300, allowing for genetic "hitchhiking" of SCCmec. SCCmec in turn protects against exposure to beta-lactams.
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- 2008
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33. Emergence of multidrug-resistant, community-associated, methicillin-resistant Staphylococcus aureus clone USA300 in men who have sex with men.
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Diep BA, Chambers HF, Graber CJ, Szumowski JD, Miller LG, Han LL, Chen JH, Lin F, Lin J, Phan TH, Carleton HA, McDougal LK, Tenover FC, Cohen DE, Mayer KH, Sensabaugh GF, and Perdreau-Remington F
- Subjects
- Communicable Diseases, Emerging transmission, Community Health Services, Community-Acquired Infections epidemiology, Community-Acquired Infections microbiology, Community-Acquired Infections transmission, Cross-Sectional Studies, Drug Resistance, Multiple, Bacterial, Humans, Incidence, Male, Methicillin Resistance, Retrospective Studies, Risk Factors, San Francisco epidemiology, Sexually Transmitted Diseases, Bacterial epidemiology, Sexually Transmitted Diseases, Bacterial microbiology, Staphylococcal Infections transmission, Communicable Diseases, Emerging epidemiology, Communicable Diseases, Emerging microbiology, Homosexuality, Staphylococcal Infections epidemiology, Staphylococcal Infections microbiology, Staphylococcus aureus
- Abstract
Background: Infection with multidrug-resistant, community-associated, methicillin-resistant Staphylococcus aureus (MRSA) has been reported but seems to be isolated., Objective: To determine the incidence of a multidrug-resistant MRSA clone (USA300) in San Francisco, and to determine risk factors for the infection., Design: Population-based survey and cross-sectional study using chart review., Setting: 9 hospitals in San Francisco (population-based survey) and 2 outpatient clinics in San Francisco and Boston (cross-sectional study)., Patients: Persons with culture-proven MRSA infections in 2004 to 2006., Measurements: Annual incidence, spatial clustering, and risk factors for multidrug-resistant USA300 infection. Pulsed-field gel electrophoresis, polymerase chain reaction assays, and DNA sequencing were used to characterize MRSA isolates., Results: The overall incidence of multidrug-resistant USA300 infection in San Francisco was 26 cases per 100,000 persons (95% CI, 16 to 36 cases per 100,000 persons); the incidence was higher in 8 contiguous ZIP codes with a higher proportion of male same-sex couples. Male-male sex was a risk factor for multidrug-resistant USA300 infection (relative risk, 13.2 [CI, 1.7 to 101.6]; P < 0.001) independent of past MRSA infection (relative risk, 2.1 [CI, 1.2 to 3.7]; P = 0.007) or clindamycin use (relative risk, 2.1 [1.2 to 3.6]; P = 0.007). The risk seemed to be independent of HIV infection. In San Francisco, multidrug-resistant USA300 manifested most often as infection of the buttocks, genitals, or perineum. In Boston, the infection was recovered exclusively from men who had sex with men., Limitations: The study was retrospective, and sexual risk behavior was not assessed., Conclusion: Infection with multidrug-resistant USA300 MRSA is common among men who have sex with men, and multidrug-resistant MRSA infection might be sexually transmitted in this population. Further research is needed to determine whether existing efforts to control epidemics of other sexually transmitted infections can control spread of community-associated, multidrug-resistant MRSA.
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- 2008
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34. Randomized, double-blind, placebo-controlled trial of cephalexin for treatment of uncomplicated skin abscesses in a population at risk for community-acquired methicillin-resistant Staphylococcus aureus infection.
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Rajendran PM, Young D, Maurer T, Chambers H, Perdreau-Remington F, Ro P, and Harris H
- Subjects
- Abscess drug therapy, Abscess pathology, Adult, Aged, Anti-Bacterial Agents therapeutic use, Community-Acquired Infections microbiology, Community-Acquired Infections pathology, Double-Blind Method, Female, Humans, Male, Microbial Sensitivity Tests, Middle Aged, Staphylococcal Infections pathology, Staphylococcal Skin Infections drug therapy, Staphylococcal Skin Infections pathology, Treatment Outcome, Cephalexin therapeutic use, Community-Acquired Infections drug therapy, Methicillin Resistance, Staphylococcal Infections drug therapy, Staphylococcus aureus drug effects
- Abstract
Empirical use of beta-lactam antibiotics, the preferred agents for treating uncomplicated skin and soft tissue infections, may no longer be appropriate for these infections because of the increasing prevalence of community strains of methicillin-resistant Staphylococcus aureus (MRSA). Retrospective studies, however, suggest that outcomes are good even when beta-lactams are used. We conducted a randomized, double-blind trial of 166 outpatient subjects comparing placebo to cephalexin at 500 mg orally four times for 7 days after incision and drainage of skin and soft tissue abscesses. The primary outcome was clinical cure or failure 7 days after incision and drainage. S. aureus was isolated from 70.4% of abscess cultures. Of the isolates tested 87.8% were MRSA, 93% of which were positive for Panton-Valentine leucocidin genes. Clinical cure rates were 90.5% (95% confidence interval, 0.82 to 0.96) in the 84 placebo recipients and 84.1% (95% confidence interval, 0.74 to 0.91) in the 82 cephalexin recipients (difference in the two proportions, 0.0006; 95% confidence interval, -0.0461 to 0.0472; P = 0.25). The 90.5% cure rate observed in the placebo arm and 84.1% cure rate observed in the cephalexin arm provide strong evidence that antibiotics may be unnecessary after surgical drainage of uncomplicated skin and soft tissue abscesses caused by community strains of MRSA.
- Published
- 2007
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35. Differences in clinical and molecular characteristics of skin and soft tissue methicillin-resistant Staphylococcus aureus isolates between two hospitals in Northern California.
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Bhattacharya D, Carleton H, Tsai CJ, Baron EJ, and Perdreau-Remington F
- Subjects
- Adult, Anti-Bacterial Agents pharmacology, California epidemiology, Community-Acquired Infections epidemiology, Community-Acquired Infections microbiology, Community-Acquired Infections physiopathology, Female, Hospitals, Hospitals, Urban, Humans, Male, Microbial Sensitivity Tests, Middle Aged, Prevalence, Staphylococcal Infections epidemiology, Staphylococcal Infections microbiology, Staphylococcal Infections physiopathology, Staphylococcus aureus drug effects, Staphylococcus aureus genetics, Staphylococcus aureus isolation & purification, Suburban Population, Methicillin Resistance, Soft Tissue Infections epidemiology, Soft Tissue Infections microbiology, Soft Tissue Infections physiopathology, Staphylococcal Skin Infections epidemiology, Staphylococcal Skin Infections microbiology, Staphylococcal Skin Infections physiopathology, Staphylococcus aureus classification
- Abstract
Community-onset methicillin-resistant Staphylococcus aureus (CO-MRSA) skin and soft tissue infections (SSTI) are associated with SCCmec IV and Panton-Valentine leukocidin (PVL) genes. CO-MRSA epidemiologic studies suggest that genotypic variation exists within one geographic region. We compared MRSA genotypes and demographic and clinical characteristics of patients with CO-MRSA SSTI between two regional medical centers. We also examined factors associated with SCCmec IV and PVL carriage. A total of 279 MRSA SSTI isolates from 2000 to 2002 at San Francisco General Hospital (SFGH) and Stanford University Hospital (SUH) were genotyped by pulsed-field gel electrophoresis and PCR for SCCmec and PVL genes. Medical records were reviewed for clinical characteristics. Ninety-three percent and 69% of MRSA SSTI were caused by CO-MRSA at SFGH and SUH, respectively. Patients with CO-MRSA SSTI at SFGH were more likely to be nonwhite, younger, homeless, and have no previous exposure to health care (P < 0.01). SFGH CO-MRSA strains were more likely to carry SCCmec type IV and PVL genes (90% and 55%, respectively) than SUH strains (29% and 16%, respectively). In multivariate analyses, nonwhite ethnicity was associated with both SCCmec type IV and PVL carriage (odds ratio [OR] of 2.65 and 95% confidence interval [CI] of 1.19 to 5.95 and OR of 1.94 and 95% CI of 1.03 to 3.65, respectively). ST8:USA300:IV became the dominant clone at SFGH, but not at SUH, by 2002. Despite geographic proximity, CO-MRSA SSTI exhibited differing SCCmec types, PVL carriage, and clonal dynamics. CO-MRSA SSTI at SUH were more likely to represent feral isolates of nosocomial origin. Clinicians should assess for nosocomial and community risk factors, realizing that different populations with CO-MRSA SSTI may require separate antimicrobial strategies.
- Published
- 2007
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36. Intermediate vancomycin susceptibility in a community-associated MRSA clone.
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Graber CJ, Wong MK, Carleton HA, Perdreau-Remington F, Haller BL, and Chambers HF
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- Community-Acquired Infections drug therapy, Community-Acquired Infections microbiology, Daptomycin pharmacology, Humans, Lumbar Vertebrae microbiology, Male, Methicillin Resistance, Microbial Sensitivity Tests, Middle Aged, Osteomyelitis drug therapy, Osteomyelitis microbiology, Staphylococcal Infections drug therapy, Staphylococcus aureus isolation & purification, Thrombophlebitis drug therapy, Treatment Outcome, Vancomycin therapeutic use, Anti-Bacterial Agents pharmacology, Methicillin pharmacology, Staphylococcal Infections microbiology, Staphylococcus aureus drug effects, Vancomycin pharmacology
- Abstract
We describe a case of treatment failure caused by a strain of USA300 community-associated methicillin-resistant Staphylococcus aureus (MRSA) with intermediate susceptibility to vancomycin and reduced susceptibility to daptomycin. The strain was isolated from the bone of a 56-year-old man with lumbar osteomyelitis after a 6-week treatment course of vancomycin for catheter-associated septic thrombophlebitis.
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- 2007
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37. Clinical and epidemiologic characteristics cannot distinguish community-associated methicillin-resistant Staphylococcus aureus infection from methicillin-susceptible S. aureus infection: a prospective investigation.
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Miller LG, Perdreau-Remington F, Bayer AS, Diep B, Tan N, Bharadwa K, Tsui J, Perlroth J, Shay A, Tagudar G, Ibebuogu U, and Spellberg B
- Subjects
- Adult, Age Distribution, Anti-Bacterial Agents administration & dosage, Community-Acquired Infections drug therapy, Community-Acquired Infections epidemiology, Community-Acquired Infections microbiology, Diagnosis, Differential, Female, Follow-Up Studies, Hospitalization, Humans, Incidence, Male, Microbial Sensitivity Tests, Middle Aged, Multivariate Analysis, Polymerase Chain Reaction, Probability, Prospective Studies, Risk Factors, Severity of Illness Index, Sex Distribution, Staphylococcal Infections drug therapy, Staphylococcus aureus drug effects, Staphylococcus aureus isolation & purification, Treatment Outcome, Community-Acquired Infections diagnosis, Methicillin Resistance, Staphylococcal Infections diagnosis, Staphylococcal Infections epidemiology
- Abstract
Background: Community-associated (CA) methicillin-resistant Staphylococcus aureus (MRSA) infection has become common worldwide. Some researchers have argued that empirical therapy for MRSA should be given only to patients with suspected CA S. aureus infections who have risk factors for acquisition of MRSA. However, there are no prospective data examining this approach., Methods: We prospectively enrolled consecutive patients who were hospitalized with S. aureus infection, administered a detailed questionnaire, and collected clinical and microbiological information., Results: Of the 280 consenting patients, 180 were adults with CA S. aureus infection. Among these subjects, 108 (60%) had MRSA infection, and 78 (40%) had methicillin-susceptible S. aureus (MSSA) infection. MRSA infection was associated with younger age (P<.0001); skin/soft-tissue infection (P=.015); snorting/smoking illegal drugs (P=.01); recent incarceration (P=.03); lower comorbidity index (P=.01); more frequent visits to bars, raves, and/or clubs (P=.03); and higher frequency of laundering clothes in hot water (P=.05). However, the sensitivity, specificity, and predictive values for these factors for discriminating CA-MRSA infection from CA-MSSA infection were relatively poor. Post-hoc modeling revealed that, even in a 10% (i.e., low) MRSA prevalence population, patients lacking the 3 strongest MRSA risk factors would still have a 7% posttest probability of MRSA. Most MRSA strains belonged to the ST-8/USA300 genotype, contained SCCmec type IV, and shared virulence factors commonly found in the ST1:USA400 clone. MSSA strains were genotypically heterogeneous., Conclusions: We found that clinical and epidemiological risk factors in persons hospitalized for CA S. aureus infection cannot reliably distinguish between MRSA and MSSA. Our findings have important implications for the choice of empirical antibiotic therapy for suspected S. aureus infections and for infection control.
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- 2007
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38. Community-associated methicillin-resistant Staphylococcus aureus necrotizing fasciitis in a neonate.
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Dehority W, Wang E, Vernon PS, Lee C, Perdreau-Remington F, and Bradley J
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- Humans, Infant, Newborn, Male, Community-Acquired Infections microbiology, Fasciitis, Necrotizing microbiology, Methicillin Resistance, Staphylococcal Infections microbiology, Staphylococcus aureus drug effects
- Abstract
Neonatal necrotizing fasciitis is rare and is predominantly associated with methicillin-susceptible Staphylococcus aureus (MSSA). Necrotizing fasciitis associated with community-associated methicillin-resistant S aureus (CA-MRSA) has only recently been reported in the literature, primarily among adults. We present a case of a previously healthy neonate with necrotizing fasciitis of the back caused by CA-MRSA, pulsed-field type USA-300. We describe a 5-day-old infant with necrotizing fasciitis of the back caused by CA-MRSA. Treatment of necrotizing fasciitis requires prompt medical evaluation, prompt surgical debridement, and appropriate antibiotic selection. The potential involvement of CA-MRSA in necrotizing fasciitis in children needs to be considered before institution of antibiotics.
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- 2006
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39. Ophthalmic manifestations of infections caused by the USA300 clone of community-associated methicillin-resistant Staphylococcus aureus.
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Rutar T, Chambers HF, Crawford JB, Perdreau-Remington F, Zwick OM, Karr M, Diehn JJ, and Cockerham KP
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- Adult, Aged, Eye Diseases pathology, Eye Diseases physiopathology, Eye Diseases therapy, Female, Humans, Male, Middle Aged, Prospective Studies, Staphylococcus aureus genetics, Treatment Outcome, Community-Acquired Infections complications, Community-Acquired Infections microbiology, Eye Diseases microbiology, Methicillin Resistance, Staphylococcal Infections complications, Staphylococcal Infections microbiology, Staphylococcus aureus physiology
- Abstract
Purpose: To report the microbiological, clinical, and pathological characteristics of community-associated methicillin-resistant Staphylococcus aureus (CAMRSA) infections of the eye and orbit., Design: Prospective case series., Participants: Nine patients with CAMRSA infections of the eye and orbit were identified during a 6-month period at 2 tertiary care hospitals in San Francisco., Methods: Case identification was by prospective case selection and retrospective laboratory review of 549 MRSA cultures collected in the 2 hospitals. Ophthalmic microbial isolates were analyzed by pulsed-field gel electrophoresis and compared with a control CAMRSA clone (USA300). Clinical characteristics of patients infected with CAMRSA were reviewed, and all surgical specimens underwent pathological examination., Main Outcome Measures: Pulsed-field gel electrophoresis banding patterns of MRSA isolates, antibiotic sensitivity profiles, patient demographics, systemic and ocular complications of infection, and posttreatment visual acuities., Results: Nine ophthalmic isolates were CAMRSA clone USA300. The infections included orbital cellulitis, endogenous endophthalmitis, panophthalmitis, lid abscesses, and septic venous thrombosis. Patients were treated with trimethoprim-sulfamethoxazole, rifampin, clindamycin, or vancomycin based on microbial sensitivity studies and severity of infection. Eight of the 9 patients had no history of hospitalization. Seven patients required hospitalization, 3 required surgery, and an additional 4 required invasive procedures. Eight patients had good visual outcomes, but 1 deteriorated to no light perception. Pathological analyses showed extensive necrosis in eyelid and orbital specimens, and disorganized atrophy bulbi in an enucleated eye., Conclusion: The USA300 CAMRSA clone, which carries Panton-Valentine leukocidin genes, can cause aggressive infections of the eye and orbit in hospital-naive patients. Treatment of infections often required debridement of necrotic tissues in addition to non-beta-lactam class antibiotics. In communities where CAMRSA is prevalent, ophthalmologists should obtain microbial cultures and sensitivity studies to help guide antibiotic therapy for severe ophthalmic infections.
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- 2006
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40. New Staphylococcus aureus genotyping method based on exotoxin (set) genes.
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Aguiar-Alves F, Medeiros F, Fernandes O, Gudziki Pereira RM, Perdreau-Remington F, and Riley LW
- Subjects
- DNA, Bacterial genetics, Genotype, Humans, Phylogeny, Polymerase Chain Reaction, Polymorphism, Single Nucleotide, Sequence Analysis, DNA, Staphylococcal Infections microbiology, Staphylococcus aureus genetics, Bacterial Proteins genetics, Bacterial Typing Techniques, Exotoxins genetics, Staphylococcus aureus classification
- Abstract
A variety of methods for genotyping Staphylococcus aureus isolates exists: the two most widely used methods are pulsed-field gel electrophoresis (PFGE) and multilocus sequence typing (MLST). Here, we describe a sequence-based genotyping method based on genes encoding S. aureus superantigen-like proteins, which belong to a family of exotoxins called staphylococcal exotoxins. The sequences of PCR-amplified internal fragments of three different set genes (set2, set5, and set7) of 61 well-characterized clinical methicillin-resistant S. aureus (MRSA) and methicillin-susceptible S. aureus (MSSA) isolates and reference strains were compared. Phylogenetic analysis was performed based on single-nucleotide polymorphisms (SNP). The SNP dendrograms of the set gene sequences differentiated the 61 isolates into 22 distinct subgroups, designated exotoxin sequence types (ETST), while the standard seven-gene MLST profiles differentiated the same 61 isolates into 19 subgroups. Of the 19 different MLST subgroups, 16 corresponded to 16 distinct ETST groups. However, three MLST subgroups, ST1, ST30, and ST36, were each further separated into more than one ETST subgroup. The exotoxin-based genotyping method was able to discriminate MRSA and MSSA isolates according to their specific epidemiological characteristics. This SNP analysis of the three set genes is thus equally or more discriminatory than the seven-gene MLST method, providing a good alternative typing tool for a laboratory that has sequencing capability.
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- 2006
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41. Multidrug-resistant Escherichia coli clonal groups causing community-acquired bloodstream infections.
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Manges AR, Perdreau-Remington F, Solberg O, and Riley LW
- Subjects
- Adolescent, Adult, Aged, Aged, 80 and over, Anti-Bacterial Agents pharmacology, Child, Child, Preschool, DNA, Bacterial analysis, Electrophoresis, Gel, Pulsed-Field, Escherichia coli drug effects, Escherichia coli Infections microbiology, Female, Humans, Infant, Infant, Newborn, Male, Microbial Sensitivity Tests, Middle Aged, Polymerase Chain Reaction, Trimethoprim Resistance, Trimethoprim, Sulfamethoxazole Drug Combination, Urinary Tract Infections microbiology, Bacteremia microbiology, Community-Acquired Infections microbiology, Drug Resistance, Multiple, Bacterial, Escherichia coli classification, Escherichia coli genetics
- Abstract
Objectives: A multidrug-resistant Escherichia coli clonal group (designated CgA) has been isolated from women with cystitis and pyelonephritis in several communities. This study was designed to determine if CgA can cause community-acquired bloodstream infections., Methods: All community-acquired bloodstream infections caused by E. coli identified at the San Francisco General Hospital between May 2001 and May 2003 were included. The diagnosis of septicemia was based on admission diagnosis. E. coli isolates were characterized by antibiotic susceptibility profile, enterobacterial repetitive intergenic consensus (ERIC2) PCR, serogrouping, and pulsed field gel electrophoresis (PFGE)., Results: A total of 127 individuals with a community-acquired bloodstream infection were identified; 48 (39%) were trimethoprim-sulfamethoxazole (SXT)-resistant. CgA, as defined by ERIC2 PCR, was responsible for 19 (15%) of these infections. Infection with a CgA isolate was associated with an admission diagnosis of cystitis or pyelonephritis (p=0.01). By PFGE, none of the CgA isolates were indistinguishable to the prototype cystitis strain; however, nine bloodstream isolates differed by fewer than six bands., Conclusions: CgA can cause community-acquired bloodstream infections, but does not appear to cause a disproportionate number of severe extraintestinal infections. This study provides evidence that UTI-causing clonal groups can cause a wide spectrum of disease and are an important clinical and public health concern.
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- 2006
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42. Roles of 34 virulence genes in the evolution of hospital- and community-associated strains of methicillin-resistant Staphylococcus aureus.
- Author
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Diep BA, Carleton HA, Chang RF, Sensabaugh GF, and Perdreau-Remington F
- Subjects
- Bacterial Toxins genetics, DNA Fingerprinting, DNA, Bacterial genetics, Electrophoresis, Gel, Pulsed-Field, Enterotoxins genetics, Exotoxins genetics, Gene Transfer, Horizontal, Genotype, Humans, Leukocidins, Methicillin Resistance genetics, Polymerase Chain Reaction, Polymorphism, Restriction Fragment Length, San Francisco, Staphylococcus aureus classification, Staphylococcus aureus drug effects, Staphylococcus aureus isolation & purification, Superantigens genetics, Community-Acquired Infections microbiology, Cross Infection microbiology, Evolution, Molecular, Staphylococcal Infections microbiology, Staphylococcus aureus genetics, Virulence Factors genetics
- Abstract
Background: The extent to which the horizontal transfer of virulence genes has contributed to the emergence of contemporary virulent strains of methicillin-resistant Staphylococcus aureus (MRSA) in hospital and community settings is poorly understood., Methods: Epidemiologically well-characterized MRSA isolates collected over 8.5 years were genotyped and tested for the presence of 34 virulence genes., Results: Six strain types accounted for 88.2% of all MRSA infections. The evolution of contemporary hospital and community phenotypes within the CC8 and CC30 lineages--2 background genomes that produced historical pandemic MRSA clones--were associated with multiple horizontal acquisitions of virulence genes. The epidemic community phenotype of a CC8 strain, designated ST8:USA300, was linked to the acquisition of staphylococcal cassette chromosome (SCC)mec type IV, the genes for Panton-Valentine leukocidin (PVL), and the enterotoxin Q and K genes. Similarly, the epidemic community phenotype of a CC30 strain, ST30:USA1100, was linked to the acquisition of SCCmec type IV and the pvl genes. In contrast, the epidemic hospital phenotype of another CC30 strain, ST36:USA200, was associated with the acquisition of SCCmec type II, the enterotoxin A gene, and the toxic shock syndrome toxin 1 gene. The pvl genes appear not to be essential for the evolution OF other community-associated strains of mrsa, including ST8:USA500 and ST59:USA1000., Conclusions: The horizontal transfer of virulence genes, although infrequent, is epidemiologically associated with the emergence of new virulent strains of MRSA.
- Published
- 2006
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43. Fatal community-associated methicillin-resistant Staphylococcus aureus pneumonia in an immunocompetent young adult.
- Author
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Frazee BW, Salz TO, Lambert L, and Perdreau-Remington F
- Subjects
- Adult, Community-Acquired Infections diagnosis, Community-Acquired Infections drug therapy, Community-Acquired Infections immunology, Community-Acquired Infections microbiology, Diagnosis, Differential, Fatal Outcome, Humans, Immunocompetence, Male, Pneumonia, Pneumococcal diagnosis, Pneumonia, Staphylococcal immunology, Pneumonia, Staphylococcal microbiology, Staphylococcus aureus isolation & purification, Methicillin Resistance, Pneumonia, Staphylococcal diagnosis, Pneumonia, Staphylococcal drug therapy
- Abstract
Severe pneumonia caused by community-associated methicillin-resistant Staphylococcus aureus (MRSA) was reported in children soon after this pathogen emerged in the United States in the 1990s. Genes for Panton Valentine leukocidin, which are present in the majority of community-associated MRSA, are thought to enhance the ability of S aureus to cause necrotizing pneumonia. Despite the rapid spread throughout the United States of community-associated MRSA and related skin and soft-tissue infections, reports of severe pneumonia in adults have been rare. We describe a case of a healthy young adult who initially was treated as an outpatient with levofloxacin for what appeared to be typical community-acquired pneumonia. He soon returned to the emergency department (ED) with rapidly fatal necrotizing pneumonia, associated with hemoptysis, leukopenia, and sepsis syndrome, that was caused by community-associated MRSA carrying genes for Panton Valentine leukocidin. This case highlights the typical features of this form of pneumonia and the need to consider MRSA when evaluating and treating severe pneumonia in the ED. It also raises the question of whether the incidence of this form of pneumonia might be increasing in communities with a high prevalence of community-associated MRSA and whether current pneumonia treatment guidelines should be modified.
- Published
- 2005
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44. Molecular evolution of methicillin-resistant Staphylococcus aureus in the metropolitan area of Cologne, Germany, from 1984 to 1998.
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Wisplinghoff H, Ewertz B, Wisplinghoff S, Stefanik D, Plum G, Perdreau-Remington F, and Seifert H
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- Electrophoresis, Gel, Pulsed-Field, Genes, Bacterial genetics, Genetic Variation, Germany epidemiology, Hospitals, Humans, Methicillin Resistance, Staphylococcal Infections microbiology, Urban Population, Evolution, Molecular, Methicillin pharmacology, Staphylococcal Infections epidemiology, Staphylococcus aureus drug effects, Staphylococcus aureus genetics
- Abstract
To investigate the molecular evolution of methicillin-resistant Staphylococcus aureus (MRSA) in a large metropolitan area in Germany, 398 nonrepetitive MRSA isolates recovered from patients from various teaching and nonteaching hospitals in Cologne between 1984 and 1998 were characterized by pulsed-field gel electrophoresis (PFGE). On this basis, 95 representative isolates were selected and further investigated by multilocus sequence typing (MLST), spa typing, and staphylococcal cassette chromosome mec (SCCmec) typing. Overall, there were 9 MLST types and 16 spa types. The most prevalent sequence types (STs) were ST239 (38% of isolates), ST247 (29%), and ST228 (18%); the most prevalent spa types were 37 (32%) and 51 (29%). ST239 comprised five major PFGE types and various unique PFGE patterns, and ST5 comprised two PFGE types. While the same PFGE pattern was not observed among strains with different STs, spa type 37 was observed among strains representing two different STs (ST239 and ST241), and these belonged to the same clonal complex as single-locus variants. ST239 was the earliest predominant ST, with the highest prevalence from 1984 to 1988 (96%), followed by ST247 from 1989 to 1993 (83%) and ST228 from 1994 to 1998 (40%). Spa type 37 was the most prevalent from 1984 to 1988 (96%), spa type 51 was the most prevalent from 1989 to 1993 (83%), and spa types 1 and 458 were the most prevalent from 1994 to 1998 (26% and 14%, respectively). The prevalence of SCCmec type III decreased from 96% from 1984 to 1988 to 8% from 1989 to 1993, the prevalence of SCCmec type I increased from 4% from 1984 to 1988 to 97% from 1989 to 1993 and decreased to 62% from 1994 to 1998. While the genetic diversity of MRSA increased from 1984 to 1998, one prevalent ST usually accounted for most of the isolates in a given time period.
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- 2005
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45. Impact of a formulary switch from ticarcillin-clavulanate to piperacillin-tazobactam on colonization with vancomycin-resistant enterococci.
- Author
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Winston LG, Charlebois ED, Pang S, Bangsberg DR, Perdreau-Remington F, and Chambers HF
- Subjects
- Carrier State prevention & control, Cross Infection prevention & control, Female, Formularies, Hospital as Topic, Gastrointestinal Tract microbiology, Humans, Intensive Care Units standards, Male, Middle Aged, Penicillanic Acid analogs & derivatives, Piperacillin, Tazobactam Drug Combination, Prospective Studies, Risk Factors, Time Factors, Anti-Bacterial Agents therapeutic use, Clavulanic Acids therapeutic use, Enterococcus faecium drug effects, Penicillanic Acid therapeutic use, Piperacillin therapeutic use, Ticarcillin therapeutic use, Vancomycin Resistance drug effects
- Abstract
Background: The prevalence of vancomycin-resistant enterococci (VRE) is increasing, despite infection control measures. Limited data link ticarcillin-clavulanate to higher VRE prevalence., Methods: Active surveillance for VRE was conducted before and after a formulary switch from ticarcillin-clavulanate to piperacillin-tazobactam. Rectal swabs were obtained serially in 863 adult patients admitted to intensive care units (ICUs) between November 1, 2000 and September 30, 2004., Results: In the postswitch period, 38 of 497 (7.6%) patients acquired VRE versus 42 of 366 (11.5%) patients in the preswitch period. Survival analysis showed an overall hazard ratio (HR) of .68 postswitch versus preswitch ( P = .07), with the greatest change in the surgical ICU (HR = .17, P = .006). Multivariate analysis showed an overall HR = .51 ( P = .004). Hospital-wide, nonstool VRE clinical cultures fell from 39 (.58/1000 patient days) in the 10-month preswitch period to 27 (.33/1000 patient days) in the 12-month postswitch period. Infection control practices and use of other antibiotics remained stable., Conclusions: VRE acquisition appeared to decrease in association with a formulary change from ticarcillin-clavulanate to piperacillin-tazobactam.
- Published
- 2004
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46. Community-adapted methicillin-resistant Staphylococcus aureus (MRSA): population dynamics of an expanding community reservoir of MRSA.
- Author
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Carleton HA, Diep BA, Charlebois ED, Sensabaugh GF, and Perdreau-Remington F
- Subjects
- Anti-Bacterial Agents pharmacology, DNA Fingerprinting, DNA, Bacterial analysis, Genotype, Humans, Inpatients, Microbial Sensitivity Tests, Molecular Epidemiology, Outpatients, Polymorphism, Restriction Fragment Length, San Francisco epidemiology, Sequence Analysis, DNA, Staphylococcal Infections epidemiology, Staphylococcus aureus classification, Staphylococcus aureus drug effects, Staphylococcus aureus isolation & purification, Community-Acquired Infections microbiology, Methicillin Resistance, Staphylococcal Infections microbiology, Staphylococcus aureus genetics
- Abstract
To define methicillin-resistant Staphylococcus aureus (MRSA) reservoirs in the community and their population dynamics, we studied the molecular epidemiology of a random sample (n=490) from a collection of 2154 inpatient and outpatient MRSA isolates during a 7-year period in San Francisco. We noted a progressive replacement of type II staphylococcal chromosomal cassette (SCC)mec-bearing isolates with type IV SCCmec-bearing isolates, which coincided with >4-fold increase in methicillin resistance between 1998 and 2002. Type IV SCCmec-bearing isolates involved in the increase in methicillin resistance belonged to 4 molecular genotypes. These 4 genotypes were associated predominantly with community-onset disease, rather than hospital- or long-term-care facility-onset disease (76.9% vs. 19.4% vs. 3.7%; P=.0005), suggesting that they are not feral descendants of hospital isolates. The longitudinal results linked the dramatic increase in MRSA infections to an expanding community reservoir of MRSA genotypes with intrinsic community survival advantage.
- Published
- 2004
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47. An epidemic of methicillin-resistant Staphylococcus aureus soft tissue infections among medically underserved patients.
- Author
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Young DM, Harris HW, Charlebois ED, Chambers H, Campbell A, Perdreau-Remington F, Lee C, Mankani M, Mackersie R, and Schecter WP
- Subjects
- Community-Acquired Infections drug therapy, Female, Humans, Logistic Models, Male, Prevalence, Retrospective Studies, Risk Factors, San Francisco epidemiology, Soft Tissue Infections drug therapy, Staphylococcal Infections drug therapy, Staphylococcus aureus drug effects, Community-Acquired Infections epidemiology, Disease Outbreaks, Medical Indigency, Methicillin Resistance, Soft Tissue Infections epidemiology, Staphylococcal Infections epidemiology
- Abstract
Hypothesis: A high prevalence of methicillin-resistant Staphylococcus aureus (MRSA) in soft tissue infections presents a treatment challenge., Design: Retrospective analysis., Setting: The San Francisco General Hospital Integrated Soft Tissue Infection (ISIS) Clinic., Patients: Patients treated at the ISIS Clinic from July 1, 2000, to June 30, 2003., Main Outcome Measures: Information on patient demographics, surgical procedures, microbiologic studies, and antibiotic treatments was obtained for all patients treated in the ISIS Clinic. Microbial data and antibiotic susceptibility pattern of S aureus, treatment outcome, and antibiotic prescribed were analyzed for all evaluable patients., Results: The ISIS Clinic treated 6156 unique patients for 12,012 episodes of infection. In this cohort, 5164 (84%) were either homeless or had no health insurance. More than half of the patients (58%) were injection drug users, but most had only 1 prior visit to the clinic (62%). Patients underwent a surgical procedure 7707 times (64%). Of the 837 positive cultures obtained, S aureus was recovered 695 times (83%), and 525 (63%) of the cultures contained MRSA. Therefore, a full 76% of all S aureus isolated was MRSA. In a subset analysis of 622 cultures collected prospectively from consecutive patients, 282 (45%) grew organisms, of which 256 (91%) were S aureus. MRSA represented 59% of all S aureus isolated. Homelessness and injection drug use were risk factors for infection by S aureus and MRSA. In another subgroup of patients with soft tissue infections that required admission to the hospital, MRSA was recovered from the cultures in 149 patients. In these patients with MRSA, 44 (30%) only received a beta-lactam antibiotic, inactive against MRSA, and had full resolution of their infection., Conclusions: The prevalence of MRSA soft tissue infections in the medically underserved ISIS Clinic cohort is extremely high. The transmission of the MRSA seems to be in the community. Antibiotic therapy directed at MRSA may not be needed in a large number of patients with these soft tissue infections. Studies to identify the source and cause of this MRSA outbreak are urgently needed. Clinical trials to examine the need for antibiotic therapy in soft tissue infections should be conducted.
- Published
- 2004
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48. Widespread skin and soft-tissue infections due to two methicillin-resistant Staphylococcus aureus strains harboring the genes for Panton-Valentine leucocidin.
- Author
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Diep BA, Sensabaugh GF, Somboonna N, Carleton HA, and Perdreau-Remington F
- Subjects
- Bacterial Toxins, Community-Acquired Infections microbiology, Cross Infection microbiology, Exotoxins, Humans, San Francisco, Staphylococcus aureus classification, Staphylococcus aureus isolation & purification, Genes, Bacterial, Leukocidins genetics, Methicillin Resistance genetics, Soft Tissue Infections microbiology, Staphylococcal Infections microbiology, Staphylococcal Skin Infections microbiology, Staphylococcus aureus drug effects, Staphylococcus aureus genetics
- Abstract
Infections caused by community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) are emerging as a major public health problem. CA-MRSA has been associated previously with skin and soft-tissue infection (SSTI) and with carriage of staphylococcal cassette chromosome mec (SCCmec) type IV and the Panton-Valentine leucocidin (PVL) virulence factor. To assess the clonal distribution of PVL-carrying strains and the association with SSTI in the San Francisco Bay area, we surveyed six collections of S. aureus isolates-671 isolates in all-collected between 1997 and 2002 originating from inpatient and outpatient clinical specimens and from a community-based sampling. Isolates were genotyped by pulsed-field gel electrophoresis, multilocus restriction fragment typing, and multilocus sequence typing and assayed for the PVL virulence factor. The S. aureus populations showed a high proportion of PVL-carrying strains, with frequencies ranging up to 70% in MRSA isolated from jail inmate patients and 69% in MRSA from patients receiving surgical treatment at an outpatient clinic specializing in treating SSTIs. PVL-carrying isolates were identified in nine clonal groups, but 88.5% of the PVL-carrying MRSA isolates belonged to only two clonal groups. These two clonal groups carried the SCCmec type IV resistance determinant and were more likely than other clonal groups to be recovered from SSTI sites than from other sites (P < 0.0001). There is evidence of clonal replacement over the period from 1999 to 2002, with one of these two clonal groups being supplanted by the other.
- Published
- 2004
- Full Text
- View/download PDF
49. Clinical, epidemiologic, and molecular evaluation of a clonal outbreak of methicillin-resistant Staphylococcus aureus infection.
- Author
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Young LS, Perdreau-Remington F, and Winston LG
- Subjects
- Bacterial Typing Techniques, California epidemiology, Case-Control Studies, Electrophoresis, Gel, Pulsed-Field, Female, Humans, Male, Microbial Sensitivity Tests, Middle Aged, Outcome Assessment, Health Care, Risk Factors, Staphylococcal Infections diagnosis, Staphylococcal Infections microbiology, Staphylococcal Infections physiopathology, Staphylococcus aureus classification, Staphylococcus aureus genetics, Disease Outbreaks, Methicillin pharmacology, Methicillin Resistance, Staphylococcal Infections epidemiology, Staphylococcus aureus drug effects
- Abstract
San Francisco General Hospital (San Francisco, CA) experienced an overall increase in the recovery of methicillin-resistant Staphylococcus aureus (MRSA) isolates that were shown by pulsed-field gel electrophoresis to have a genotype (genotype A1) that was new to this institution. We performed a case-control study to identify risk factors for acquiring genotype A1 MRSA infection from 1 October 2001 to 19 July 2002. Patients with genotype A1 MRSA infection were compared with 2 control groups: MRSA-infected control patients (i.e., patients with infection due to non-genotype A1 MRSA) and non-MRSA infected control patients (i.e., hospitalized patients without MRSA infection). There were 41 case patients infected with genotype A1 MRSA, 99 control patients infected with MRSA, and 41 control patients without MRSA infection. Pneumonia, surgical wound infections, and line infections occurred more frequently among case patients. Intensive care unit exposure and invasive procedures conferred the greatest risk for genotype A1 MRSA infection in multivariate models. Case patients were not associated with increased mortality, after adjusting for age, comorbidities, and intensive care unit exposure. Genotype A1 MRSA caused a large nosocomial outbreak of infection that was associated with distinct risk factors and clinical manifestations.
- Published
- 2004
- Full Text
- View/download PDF
50. API 20 strep identification system may incorrectly speciate enterococci with low level resistance to vancomycin.
- Author
-
Winston LG, Pang S, Haller BL, Wong M, Chambers HF 3rd, and Perdreau-Remington F
- Subjects
- Bacterial Typing Techniques standards, Enterococcus classification, Enterococcus genetics, Enterococcus isolation & purification, Humans, Microbial Sensitivity Tests instrumentation, Microbial Sensitivity Tests standards, Vancomycin pharmacology, Bacterial Typing Techniques instrumentation, Drug Resistance, Bacterial genetics, Enterococcus drug effects, Vancomycin Resistance
- Abstract
The API 20 Strep system was used to speciate 46 enterococcal isolates with vancomycin MICs between 16-32 microg/mL. All were identified as Enterococcus faecium. Further testing revealed that 42/46 isolates had been identified incorrectly. Enterococci with low-level vancomycin resistance should not be speciated solely with the API 20 Strep system.
- Published
- 2004
- Full Text
- View/download PDF
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