agr
 Dysfunction Affects Staphylococcal Cassette Chromosome
 mec
 Type-Dependent Clinical Outcomes in Methicillin-Resistant Staphylococcus aureus Bacteremia

Kang, Chang Kyung; Cho, Jeong Eun; Choi, Yoon Jeong; Jung, Younghee; Kim, Nak Hyun; Kim, Chung Jong; Kim, Taek Soo; Song, Kyoung Ho; Choe, Pyoeng Gyun; Bang, Ji Hwan; Kim, Eu Suk; Park, Kyoung Un; Kim, Nam Joong; Oh, Myoung Don; Kim, Hong Bin

doi:10.1128/aac.04962-14

Cited by 24 publications

(21 citation statements)

References 48 publications

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“…The association between strain-specific virulence and clinical outcomes of MRSA bacteremia has also been previously reported. [25][26][27] These factors may help explain the contradictory results of the meta-analysis.…”

Section: Discussionmentioning

confidence: 99%

Analysis of Staphylococcal Toxins and Clinical Outcomes of Methicillin-Resistant Staphylococcus aureus Bacteremia

Maeda

Shoji

Shirakura

et al. 2016

Biological & Pharmaceutical Bulletin

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It is well known that methicillin-resistantVancomycin (VCM) has been the standard treatment for MRSA infections for over 50 years. The area under the concentration-time curve [AUC/minimum inhibitory concentration (MIC) ratio] is a representative parameter of the pharmacokinetics-pharmacodynamics (PK-PD) of VCM.3) The Infectious Diseases Society of America recommends a target AUC/ MIC>400 for the treatment of severe MRSA infections. 4)However, this is often difficult to achieve for MRSA strains with high VCM MICs, thus increasing the risk of insufficient therapeutic response. Previous meta-analyses have attempted to address the association between MIC and clinical outcomes. [5][6][7] In contrast to these studies, a recent meta-analysis examining 8291 episodes reported no differences in the risk of death between patients with S. aureus high and low VCM MICs. 8) These results highlight the current lack of consensus regarding the relationship between VCM MICs and the prognosis of patients with MRSA infections.Our previous study measured MICs at 0.25 µg/mL intervals using the broth microdilution method and found that VCM MICs≥1.5 µg/mL affected the prognosis for MRSA bacteremia. 9) However, there were no significant differences in VCM AUC/MIC and clinical prognosis between the groups.The pathological mechanism of S. aureus infections includes infectious pathogenicity such as pneumonia, cellulitis, osteomyelitis, and infective endocarditis as well as toxic pathogenicity such as food poisoning and toxic shock syndrome.10,11) Several virulence factors have been reported to be associated with the clinical outcomes of MRSA infections. The expression of major virulence factors, such as Panton-Valentine leukocidin (PVL), is known to be correlated with higher mortality in community-associated MRSA infections. 12,13) We believe that toxic pathogenicity is closely associated with patient prognosis. S. aureus is known to produce various virulence factors, 14) such as toxic shock syndrome toxin-1 (TSST-1) and staphylococcal enterotoxins (SEs), which are superantigenic toxins (SAgT) associated with severe infections. 11,15,16) A previous study reported that TSST-1 and SEC1 caused shock when intravenously injected into an animal model. 17) In addition, recent experimental study showed that SAgT play a critical role in the development and progression of S. aureus infective endocarditis and sepsis.18) However, the association between SAgT and the prognosis of patients with MRSA bacteremia has not been sufficiently studied. Therefore, here we aimed to examine the effects of staphylococcal virulence factors on the prognosis of patients with MRSA bacteremia.

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Section: Discussionmentioning

confidence: 99%

Analysis of Staphylococcal Toxins and Clinical Outcomes of Methicillin-Resistant Staphylococcus aureus Bacteremia

Maeda

Shoji

Shirakura

et al. 2016

Biological & Pharmaceutical Bulletin

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“…7,11,[20][21][22] Regarding agr typing, group II was more frequent among MRSA isolates, as already seen in other analysis. 8,13 Its was also high among VT-MRSA and hVISA, being associated with reduced vancomycin susceptibility. 12,23,24 Many VISA are highly enriched for the agr group II.…”

Section: Population Analysis Profile -Area Under the Curve Methodsmentioning

confidence: 99%

“…3,4 Hence, its excessive and inappropriate use has led to the emergence of S. aureus with reduced vancomycin susceptibility, as vancomycin-intermediate S. aureus (VISA), heterogeneous VISA (hVISA) and afterwards, vancomycin-tolerant MRSA (VT-MRSA), last two not yet detected routinely. [5][6][7][8] Infections caused by hVISA and VISA are commonly associated with prolonged hospitalization, persistent bacteremia, and adverse clinical outcome. Although the relevance of hVISA persists unclear, studies speculate that these isolates could be a precursor of VISA phenotype.…”

Section: Introductionmentioning

confidence: 99%

Características moleculares de Staphylococcus aureus suscetível à vancomicina poderia ajudar a prever falhas no tratamento devido à reduzida suscetibilidade à vancomicina

Rossato

Reiter

Soares

et al. 2018

Rev Epidemiol Control Infect

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Justificativa e Objetivos: Staphylococcus aureus resistente à meticilina (MRSA) é uma das causas mais frequentes de infecções relacionadas à assistência à saúde e comunitárias, e com seu avanço, a vancomicina tornou-se a principal opção terapêutica. Entretanto, o seu uso indiscriminado favoreceu o surgimento de MRSA com reduzida suscetibilidade à vancomicina, comumente associados com falhas no tratamento, bacteremia persistente, hospitalização prolongada e desfechos clínicos adversos. Este estudo avaliou a ocorrência de MRSA com reduzida suscetibilidade à vancomicina e determinou algumas características moleculares em comparação com MRSA suscetível à vancomicina (VS-MRSA). Métodos: Determinação do perfil de suscetibilidade aos antimicrobianos, a concentração inibitória mínima (CIM) e concentração bactericida mínima (CBM) para vancomicina, tolerância à vancomicina, tipagem do SCCmec e agr foram realizadas em um total de 177 MRSA. Posteriormente, foram triados para hVISA por BHIA-3V e BHIA-6V e confirmados com a Análise do Perfil Populacional - Área Abaixo da Curva (PAP-AUC). Resultados: Os fenótipos VT-MRSA e hVISA foram encontrados em 13,6% e 5,1% dos isolados clínicos de MRSA, respectivamente, e a presença de hVISA foi estatisticamente significativa entre os isolados de VT-MRSA (p

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“…HA-MRSA strains have spread to the community [12]. PVL-negative ST72 MRSA is a major CA-MRSA strain [79], which has also emerged as an important healthcare-associated pathogen [11121314]. As veterans' hospitals have long-term cohorts of veterans, they are well-established models for studying HA- and CA-MRSA epidemiology and infection control in the US [1516].…”

Section: Introductionmentioning

confidence: 99%

Impact of Community-Onset Methicillin-ResistantStaphylococcus aureusonStaphylococcus aureusBacteremia in a Central Korea Veterans Health Service Hospital

et al. 2019

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Background No study has examined the epidemiology of methicillin-resistant Staphylococcus aureus (MRSA) bacteremia in Korean veterans' hospitals. We investigated the microbiological and clinical epidemiology of S. aureus bacteremia at the central Veterans Health Services (VHS) hospital in Korea. Methods Patients with S. aureus bacteremia were consecutively enrolled from February to August 2015. Bacteremia was classified as hospital-acquired (HA), community-onset healthcare-associated (COHA), or community-acquired (CA). MRSA bacteremia risk factors were analyzed. Species identification, antimicrobial susceptibility, and presence of luk and tst were tested. Staphylococcal cassette chromosome mec (SCC mec ) typing, spa sequence typing agr polymorphism typing, and multilocus sequence typing were performed. Biofilm production and δ-hemolysin activity were measured to determine agr function. Results In total, 60 patients were enrolled (30 HA, 23 COHA, and seven CA bacteremia); 44 (73.3%) had MRSA bacteremia (26 HA, 16 COHA, and two CA). MRSA bacteremia occurred more frequently in non-CA patients and those who had received antibiotic treatment within the past month ( P <0.05). The major MRSA strains comprised 24 ST5- agr 2-SCC mec II, 11 ST72- agr 1-SCC mec IV, and five ST8- agr 1-SCC mec IV strains. Of 26 agr 2-SCC mec II strains, including two MSSA strains, 25 were multidrug-resistant, 18 were tst -positive, and 13 were agr -defective, whereas only five of the 18 agr 1-SCC mec IV strains were multidrug-resistant, and all were tst -negative and agr -intact. agr 1-SCC mec IV and ST8- agr 1-SCC mec IV strains were more likely than agr 2-SCC mec II strains to be COHA. Conclusions MRSA was highly prevalent in both COHA and HA bacteremia. The introduction of virulent CA-MRSA strains may be an important cause of increased HA-MRSA bacteremia in VHS hospitals.

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agr Dysfunction Affects Staphylococcal Cassette Chromosome mec Type-Dependent Clinical Outcomes in Methicillin-Resistant Staphylococcus aureus Bacteremia

Cited by 24 publications

References 48 publications

Analysis of Staphylococcal Toxins and Clinical Outcomes of Methicillin-Resistant <i>Staphylococcus aureus</i> Bacteremia

Analysis of Staphylococcal Toxins and Clinical Outcomes of Methicillin-Resistant <i>Staphylococcus aureus</i> Bacteremia

Características moleculares de Staphylococcus aureus suscetível à vancomicina poderia ajudar a prever falhas no tratamento devido à reduzida suscetibilidade à vancomicina

Impact of Community-Onset Methicillin-ResistantStaphylococcus aureusonStaphylococcus aureusBacteremia in a Central Korea Veterans Health Service Hospital

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