INTRODUCTION Methicillin-resistant Staphylococcus aureus (MRSA) is an established nosocomial pathogen that causes infections, such as bacteremia, respiratory tract infections, skin and soft tissue infections (SSTIs), bone and joint infections, and urinary tract infections (1, 2). The prevalence rate of hospital-acquired MRSA infections was the highest (＞50) in Asia, South America, and Malta, followed by lower prevalence rates (25-50) in Australia, China, Africa, Romania, Greece, Italy, and Portugal (3). The prevalence rate of MRSA in Malaysia has been reported to increase from 17 in 1986 (4) to 44 in 2007 (5). To date, healthcare-associated MRSA (HA-MRSA) remains a global healthcare concern; however, the emergence of community-associated MRSA (CA-MRSA) since the 1990s poses significant risks and threats to both hospital and community populations. The current modality of treatment for MRSA infections is prescribing antibiotics, such as vancomycin, linezolid, rifampicin, and fusidic acid (2,6). The molecular epidemiology of MRSA can be studied using different typing methods, such as staphylococcal cassette chromosomal mec (SCCmec) typing, multilocus sequence typing (MLST), and pulsed

Concurrent bacteraemia in patients with dengue fever is rarely reported. We report a case of a patient who initially presented with symptoms typical of dengue fever but later succumbed to septic shock caused by hypervirulent methicillin-susceptible Staphylococcus aureus (MSSA). A 50-year-old female patient with hypertension and diabetes mellitus presented with typical symptoms of dengue fever. Upon investigation, the patient reported having prolonged fever for four days prior to hospitalization. Within 24 hours post-admission, the patient developed pneumonia and refractory shock, and ultimately succumbed to multiple-organs failure. Microbiological examination of the blood culture retrieved a pan susceptible MSSA strain. Genomic sequence analyses of the MSSA strain identified genes encoding staphylococcal superantigens (enterotoxin staphylococcal enterotoxin C 3 (SEC3) and enterotoxin-like staphylococcal enterotoxins-like toxin L (SElL)) that have been associated with toxic shock syndrome in human hosts. Genes encoding important toxins (Panton-Valentine leukocidins, alpha-haemolysin, protein A) involved in the development of staphylococcal pneumonia were also present in the MSSA genome. Staphylococcus aureus co-infections in dengue are uncommon but could be exceptionally fatal if caused by a toxin-producing strain. Clinicians should be aware of the risks and signs of sepsis in dengue fever, thus allowing early diagnosis and starting of antibiotic treatment in time to lower the mortality and morbidity rates.

Staphylococcus aureus (S. aureus) is an opportunistic pathogen capable of causing serious health implications in susceptible individuals once it invades the host’s protective barriers. Methicillin-susceptible S. aureus (MSSA) often receives lesser attention although it has been frequently associated with serious infections in human. We aim to investigate the genomic features of a highly virulent yet pan susceptible MSSA strain (coded as HS-MSSA) which caused concurrent bacteraemia in a dengue patient, ultimately resulted in sepsis death of the patient. Whole genome sequence analysis was performed. The draft genome of HS-MSSA is approximately 2.78 Mb (GC content = 32.7%) comprising of 2637 predicted coding sequences. In silico genotyping of the HS-MSSA strain revealed a novel combined genotype (t091/ST2990). The HS-MSSA carries a SaPIn1-like pathogenicity island that harbours the staphylococcal enterotoxin and enterotoxin-like genes (sec3 and selL). The strain-specific β-lactamase (blaZ)-bearing plasmid region was identified in HS-MSSA. Core genome phylogeny showed that the HS-MSSA strain shared a common ancestry with the European MRSA clone. We report herein the genomic features of an MSSA lineage with novel genotype previously not reported elsewhere.

No abstract

Background Methicillin-resistant Staphylococcus aureus (MRSA) bacteremia is a major concern in the global healthcare system. However, data from Asian regions dealing with the singularity of this infection in older persons is lacking. We aimed to identify the differences in the clinical characteristics and outcomes of MRSA bacteremia between adults aged 18–64 and ≥ 65 years. Methods A retrospective study cohort was conducted at the University Malaya Medical Centre (UMMC) on cases of MRSA bacteremia from 2012 to 2016. Patient demographic and clinical data were collected for risk factors analyses. Results New cases of MRSA bacteremia showed a trend of increase from 0.12 to 100 admissions in 2012 to 0.17 per 100 admissions in 2016 but a drop was observed in 2014 (0.07 per 100 admissions). Out of the 275 patients with MRSA bacteremia, 139 (50.5%) patients were aged ≥ 65 years old. Co-morbidities and severity at presentation were significantly higher among older adults, including diabetes mellitus (p = 0.035), hypertension (p = 0.001), and ischemic heart disease (p < 0.001), as well as higher Charlson Comorbidity Index (p < 0.001) and Pitt bacteremia scores (p = 0.016). Central line-associated bloodstream infections were more common among younger patients (37.5% vs. 17.3% in older patients, p < 0.001), while skin and soft tissue infections are more frequent among older adults (20.9% vs. 10.3% in younger patients, p = 0.016). All-cause mortality and in-hospital mortality were significantly higher in older patients (82.7% and 56.1% vs. 63.2% and 28.7% in younger patients, p < 0.001). Multivariate analysis revealed age ≥ 65 years (adjusted odds ratio: 3.36; 95% confidence interval: 1.24–9.13), Pitt score ≥ 3 (2.15; 1.54–3.01), hospital (6.12; 1.81–20.72) and healthcare (3.19; 1.30–7.81) acquisition of MRSA, indwelling urinary catheters (5.43; 1.39–21.23), inappropriate targeted treatment (8.08; 1.15–56.86), lack of infectious disease team consultation (2.90; 1.04–8.11) and hypoalbuminemia (3.31; 1.25–8.79), were significant risk factors for 30-day mortality. Conclusion Older patients’ risk of mortality from MRSA bacteremia was three times higher than younger patients. Our data will contribute to developing and validating a robust scoring system for risk-stratifying patients to achieve better management and improved clinical outcomes.

No abstract

No abstract

comparatively analyzed while social-community interactions were promoted Results: From week 1, 2000 to week 41, 2019 a total of 481012 cases and 11897 deaths were reported (Case fatality rate 2.5%). The 2017epidemy recorded, 54779 cases and 1157 deaths (case fatality rate 2%). In 2017, only 772 stool samples were taken of which 19% returned positive for Vibrio cholerae O1 Ogawa. During this epidemic 24 of the 26 provinces of the DRC were affected by cholera. Given the impactful situation in 2017, it was decided to bring the Diarrheal Diseases Control Program under the National Program for the Elimination of Cholera and the Control of Other Diarrheal Diseases (PNECHOL-MD), for a better coordination of activities. The emergency Water-Sanitation-Hygiene (WASH)-strategy developed by the PNECHOL-MD included massive community involvement combined with good case management in the treatment centers which with immunization helped to control this epidemic. The laboratory and microbiology aspects however should be improved.Conclusion: Specifically the extended-2017 outbreak showed the necessity of integrating the different analytical levels and actors in order to effectively master the epidemiology and infectiology. The input of social and human behavioural aspects seems essential while new and/or emerging microbiological approaches like phages-and vaccine-research are warranted especially in the light of increasing antibiotic resistances