<i>Staphylococcus aureus</i>Nasal Carriage and Infection in Patients on Hemodialysis

Yu, Victor L.; Goetz, Angella; Wagener, Marilyn M.; Smith, Peter B.; Rihs, John D.; Hanchett, James E.; Zuravleff, Jeffrey J.

doi:10.1056/nejm198607103150204

Cited by 457 publications

(219 citation statements)

References 27 publications

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“…Previous studies have identified S. aureus carriage as a risk factor for bacteremia (22,23), but S. aureus carriage did not predict bacteremia in our study. Given the relatively short duration over which isolates were prospectively collected, one of the rationales for the inclusion of isolates associated with bacteremia from the 5-year period prior to the study was to include a potentially more genetically diverse bacterial population from the same setting.…”

Section: Discussioncontrasting

confidence: 97%

Comparison of Multilocus Sequence Typing and Pulsed-Field Gel Electrophoresis as Tools for Typing Staphylococcus aureus Isolates in a Microepidemiological Setting

et al. 2002

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Multilocus sequence typing (MLST) of Staphylococcus aureus is well suited to the study of global or long-term epidemiology, but its role in local epidemiology has not been defined. The present study has compared MLST with pulsed-field gel electrophoresis (PFGE) by using S. aureus isolates associated with carriage and disease in a busy regional renal unit. One hundred forty-four patients were prospectively recruited, of whom 103 were receiving hemodialysis and 41 were on continuous ambulatory peritoneal dialysis. Three nasal swab specimens were obtained 1 month apart on entering the study. A nasal swab was positive for S. aureus on at least one occasion in 50 patients (35%). Typing of the 104 carriage isolates demonstrated 21 PFGE types and 21 sequence types (STs). Thirty-one carriers had two or more positive nasal swabs; of these, the isolates in all swabs from a given carrier had identical PFGE types for 29 carriers; the isolates in all of the same 29 swabs had identical STs. The carriage strain in two patients changed both PFGE type and STs during the period of swabbing. Eight patients (6%) had an episode of S. aureus bacteremia during the 12-month study period, and two of these were nasal carriers. One of these invasive isolates had the same PFGE type and ST as the carriage isolate. There were no differences between Simpson's index of diversity for PFGE and Simpson's index of diversity for MLST for both invasive and carriage isolates, suggesting that the two methods have very similar discriminatory abilities. We conclude that PFGE and MLST performed equally in this study.Molecular typing of the important human pathogen Staphylococcus aureus has been used to examine both long-term or global epidemiology and short-term or local epidemiology. Understanding the genetic structure of the global population over time gives insights into the evolution of bacterial lineages and transmission dynamics and also provides a framework with which to study bacterial pathogenesis. This contrasts with the typing of organisms in a defined setting over a short period of time which is used to study nosocomial outbreaks, local transmission and carriage, and the relationship between isolates associated with carriage and infection in a given individual.The attributes required of a typing tool vary depending on the application. For example, studies of nosocomial outbreaks caused by strains such as epidemic methicillin-resistant S. aureus strains are commonly performed in many centers; thus, cost, the technical expertise required, speed, reproducibility, and comparability between centers are all important issues. A range of different techniques have been described and evaluated, but pulsed-field gel electrophoresis (PFGE) is the predominant method in use for studies of outbreaks and local epidemiology (2,5,8,14,17,20). PFGE has also been successfully applied to isolates separated by geographical location (1), but it is generally considered overdiscriminatory for this type of study since the technique detects genetic variation that accum...

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Section: Discussioncontrasting

confidence: 97%

Comparison of Multilocus Sequence Typing and Pulsed-Field Gel Electrophoresis as Tools for Typing Staphylococcus aureus Isolates in a Microepidemiological Setting

et al. 2002

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“…This finding is comparable to the case of chickens with staphylococcal arthritis [15]. In humans, phage-typing studies have revealed that S. aureus strains isolated from sites of infection are often of the same phage type as those present in patients' noses [28].…”

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confidence: 72%

Characteristics of Staphylococcus intermedius Isolates from Diseased and Healthy Dogs

Sasaki

Shimizu

Kawano

et al. 2005

The Journal of Veterinary Medical Science

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ABSTRACT. Staphylococcus intermedius isolates from diseased and healthy dogs were examined for production of extracellular enzymes and toxins, and phage patterns. There were no significant differences between the two groups of isolates in the production rates of DNase, protease, lipase, gelatinase, hyaluronidase, hemolysins, protein A, and TSST-1, or in phage patterns. But the production rate of enterotoxins in isolates from diseased dogs was significantly higher than that in isolates from healthy dogs. PFGE analysis was performed with isolates from different body sites in individual dogs. In 3 of 6 healthy dogs, identical PFGE patterns were seen in isolates from the nares, external auditory meatus or skin. The remaining 3 dogs yielded isolates of different patterns. In 4 of 6 diseased dogs, identical patterns were seen in isolates from lesions as well as from the other normal sites. Staphylococcus intermedius has been considered a primary pathogen of skin infections in dogs, such as otitis externa [5,7] and pyoderma [1,22,23]. Some strains of S. intermedius produce a variety of extracellular enzymes and toxins and virulence-associated factors [1,13], which are thought to contribute to the pathogenicity of the organism.S. intermedius is also present in the nasal vestibulum, external auditory canal, anal mucosa, and on the skin surface and hair coat of healthy dogs. Knowledge of the characteristics of the normal S. intermedius flora on these sites in healthy dogs is an important factor in understanding the epidemiology of staphylococcal skin infections in dogs. There are several reports on the population sizes and frequency of the organism at these carrier sites in healthy dogs [2,3,9,22]. Nevertheless, comparison of the characteristics of isolates from different sites in individual healthy dogs has not been studied sufficiently [4]. The organism has frequently been cultured from other body sites besides lesion sites in diseased dogs, but information on the clonal relationship between the organisms in the lesions and those in the nose or skin is lacking.The purpose of this study was to compare characteristics of S. intermedius isolates from diseased dogs with those from healthy dogs by using biological properties and phage typing. In addition, the present study was to characterize isolates from different sites in individual healthy and diseased dogs, by means of pulsed-field gel electrophoresis (PFGE).A total of 96 S. intermedius isolates were subjected to biological characterization and phage typing. Forty-seven isolates were from dogs affected with otitis externa (n=8), dermatitis (n=11), pyoderma (n=7), impedigo (n=4), eczema (n=8), and folliculitis (n=9). Forty-nine isolates were from the mouth (n=3), nares (n=17), external auditory meatus (n=18), and skin (n=11) of apparently healthy dogs. Ninety of the 96 isolates had been used in a previous antimicrobial susceptibility study [26].Isolation of S. intermedius from different sites in individual healthy and diseased dogs was performed. Four of 6 healthy dogs e...

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“…However, the use of vancomycin increases the incidence of the vancomycin resistant enterococci 68,69 . Also prophylactic use of rifampicin decreases the incidence of Staphylococcus aureus infection, but its administration is associated with the risk of toxic reactions and with bacterial resistance after short-term administration 70,71 . The perigraft reaction needs to be distinguished from infectious complication.…”

Section: Preventionmentioning

confidence: 99%