Nosocomial and community-acquired meticillin-resistant Staphylococcus aureus infections in hospitalized patients (Spain, 1993–2003)

Asensio, Ángel; Cantón, Rafael; Vaqué, Josep; Rosselló, J.; Calbo, Francisco; Garcı́a-Caballero, Juan; Domı́nguez, Vicente; Hernández, Alberto Verrier; Trilla, Antoni

doi:10.1016/j.jhin.2006.03.013

Cited by 34 publications

(14 citation statements)

References 15 publications

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“…Overall, the frequency of MRSA isolates in this hospital (32.1%) coincided with that reported by the EPINE group, which surveys the prevalence of nosocomial infections in Spain (32.5% for the 2001-to-2003 period [2]), and was also in line with the results of a single-day surveillance study that analyzed 439 S. aureus isolates recovered from 143 Spanish hospitals during 2002 (30.5%) (5).…”

Section: Discussionsupporting

confidence: 88%

Clonal Complexes and Diversity of Exotoxin Gene Profiles in Methicillin-Resistant and Methicillin-Susceptible Staphylococcus aureus Isolates from Patients in a Spanish Hospital

et al. 2009

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Molecular epidemiology studies have allowed the identification of the methicillin (meticillin)-resistant (MRSA) and methicillin-susceptible (MSSA) clonal complexes (CCs) and clones of, and CC59 were also detected. Many exotoxin genes were present in each of the 81 isolates, independent of whether they were involved in sepsis (11 to 22) or other types of infections (13 to 21), and they appeared in 73 combinations. The relevant data are that (i) all isolates were positive for hemolysin and leukotoxin genes (98.8% for lukED and 25.9% for lukPV); (ii) all contained an enterotoxin gene cluster (egc with or without seu), frequently with one or more genes encoding classical enterotoxins; (iii) about half were positive for tst and 95% were positive for exfoliatin-encoding genes (eta, etb, and/or etd); and (iv) the four agr groups were detected, with agrII (55.6%) and agrIII (23.5%) being the most frequent. Taken together, results of the present study suggest a frequent acquisition and/or loss of exotoxin genes, which may be mediated by efficient intralineage transfer of mobile genetic elements and exotoxin genes therein and by eventual breakage of interlineage barriers.Staphylococcus aureus is both a commensal bacterium and an extremely versatile pathogen that causes a wide range of diseases in humans, including superficial, deep-seated, and systemic infections, as well as a variety of toxemic syndromes, such as toxic shock syndrome (TSS), staphylococcal scaldedskin syndrome (SSSS), and staphylococcal food poisoning (36). S. aureus produces a wide range of virulence factors that mediate host colonization, invasion of damaged skin and mucosa, dissemination through the body, and evasion of host defense mechanisms (8,12). Relevant among them are a variety of exotoxins that comprise ␣-, ␤-, ␥-, and ␦-hemolysins, leukotoxins (the classical LukS-PV-LukF-PV Panton-Valentine leukocidin [LukPV], LukE-LukD [LukED] and LukM-LukFЈ-PV [LukM]), exfoliative toxins, and pyrogenic toxin superantigens, such as the staphylococcal TSS toxin (TSST-1, first referred to as SEF) and staphylococcal enterotoxins (SEs) (14,29,43). Five major serological types of SEs, SEA through SEE (known as classical enterotoxins, encoded by the sea to see genes, respectively) have been initially identified. However, new types of SEs and their coding genes (seg through seu) were later reported. Several SE genes (seg, sei, sem, sen, and seo) are part of an operon termed the enterotoxin gene cluster (egc

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Section: Discussionsupporting

confidence: 88%

Clonal Complexes and Diversity of Exotoxin Gene Profiles in Methicillin-Resistant and Methicillin-Susceptible Staphylococcus aureus Isolates from Patients in a Spanish Hospital

et al. 2009

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“…In small hospitals, bacterial population sizes and frequencies are subject to strong stochastic effects and populations may frequently become extinct. It has been empirically shown that resistance levels tend to be lower in small hospitals [9], [10], [11], [12], [13]. In principle, this can be due to two reasons: On the one hand, small hospitals might be associated with different types of patients and treatments (i.e.…”

Section: Introductionmentioning

confidence: 99%

On Being the Right Size: The Impact of Population Size and Stochastic Effects on the Evolution of Drug Resistance in Hospitals and the Community

2011

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The evolution of drug resistant bacteria is a severe public health problem, both in hospitals and in the community. Currently, some countries aim at concentrating highly specialized services in large hospitals in order to improve patient outcomes. Emergent resistant strains often originate in health care facilities, but it is unknown to what extent hospital size affects resistance evolution and the resulting spillover of hospital-associated pathogens to the community. We used two published datasets from the US and Ireland to investigate the effects of hospital size and controlled for several confounders such as antimicrobial usage, sampling frequency, mortality, disinfection and length of stay. The proportion of patients acquiring both sensitive and resistant infections in a hospital strongly correlated with hospital size. Moreover, we observe the same pattern for both the percentage of resistant infections and the increase of hospital-acquired infections over time. One interpretation of this pattern is that chance effects in small hospitals impede the spread of drug-resistance. To investigate to what extent the size distribution of hospitals can directly affect the prevalence of antibiotic resistance, we use a stochastic epidemiological model describing the spread of drug resistance in a hospital setting as well as the interaction between one or several hospitals and the community. We show that the level of drug resistance typically increases with population size: In small hospitals chance effects cause large fluctuations in pathogen population size or even extinctions, both of which impede the acquisition and spread of drug resistance. Finally, we show that indirect transmission via environmental reservoirs can reduce the effect of hospital size because the slow turnover in the environment can prevent extinction of resistant strains. This implies that reducing environmental transmission is especially important in small hospitals, because such a reduction not only reduces overall transmission but might also facilitate the extinction of resistant strains. Overall, our study shows that the distribution of hospital sizes is a crucial factor for the spread of drug resistance.

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“…The reference literature for the individual countries is listed as follows: A: [7], [8], [9], [10], [11], D: [12], [13], [14], [15], [16], [17], [18], [19], DK/FI/SE/NO/IS: [20], [21], [22], [23], [24], [25] [26], ES: [27], [28], [29], [30], [31], [32], [33], [34], [35], FR: [36], [37], [38], [39], [40], HU: [41], [42], [43], IT: [44], [45], [46], [47], [48], [49], JP: [50], [51], [52], [53], [54], [55], [56], [57], [58], NL: [6], [59], [60], [61], [62], [63], [64], [65]. …”

Section: Methodsmentioning

confidence: 99%

Epidemiology of MRSA and current strategies in Europe and Japan

Krämer

Wagenvoort²,

Åhrén³

et al. 2010

GMS Krankenhaushygiene Interdisziplinär; 5(1):Doc01; ISSN 1863-5245

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Nosocomial and community-acquired meticillin-resistant Staphylococcus aureus infections in hospitalized patients (Spain, 1993–2003)

Cited by 34 publications

References 15 publications

Clonal Complexes and Diversity of Exotoxin Gene Profiles in Methicillin-Resistant and Methicillin-Susceptible Staphylococcus aureus Isolates from Patients in a Spanish Hospital

Clonal Complexes and Diversity of Exotoxin Gene Profiles in Methicillin-Resistant and Methicillin-Susceptible Staphylococcus aureus Isolates from Patients in a Spanish Hospital

On Being the Right Size: The Impact of Population Size and Stochastic Effects on the Evolution of Drug Resistance in Hospitals and the Community

Epidemiology of MRSA and current strategies in Europe and Japan

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