Persistent Wound Infection after Herniotomy Associated with Small-Colony Variants of Staphylococcus aureus

Abele‐Horn, Marianne; Schupfner, B.; Emmerling, P; Waldner, H.; Göring, H.

doi:10.1007/s150100050014

Cited by 57 publications

(51 citation statements)

References 7 publications

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“…(10). In some small, yet well-documented, case series, the clinical features of chronic infection could be directly related to the SCV phenotype (1,18,25,30,34,35). In addition, some infection models addressed the question of whether SCVs differ in virulence from isolates that show the normal phenotype.…”

Section: Discussionmentioning

confidence: 99%

“…Further characteristics are (i) altered expression of virulence genes; (ii) intracellular persistence in in vitro systems; (iii) auxotrophism for distinct growth factors, such as thymidine, hemin, and/or menadione; and (iv) the ability to revert to the normal phenotype (16,24). S. aureus SCVs can be particularly isolated in the context of chronic infections, such as osteomyelitis, persistent skin and wound infection, device-related infections, and CF lung disease (1,8,18,25,27,30,34,35). The pathogenesis of S. aureus SCVs in persistent infections is not fully understood, but one recent study has demonstrated the virulence of a site-directed hemin-auxotrophic S. aureus SCV mutant in a murine model of septic arthritis (14).…”

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confidence: 99%

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Prevalence and Clinical Significance of Staphylococcus aureus Small-Colony Variants in Cystic Fibrosis Lung Disease

Smaczny²,

et al. 2007

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Small-colony variants (SCVs) of Staphylococcus aureus can be isolated from the chronically infected airways of patients suffering from cystic fibrosis (CF). These slow-growing morphological variants have been associated with persistent and antibiotic-resistant infections, such as osteomyelitis and device-related infections, but no information is available to date regarding the clinical significance of this special phenotype in CF lung disease. We therefore investigated the prevalence of S. aureus SCVs in CF lung disease in a 12-month prospective study and correlated the microbiological culture results with the patients' clinical data. A total of 252 patients were screened for the presence of SCVs. The prevalence rate was determined to be 17% (95% confidence interval, 10 to 25%) among S. aureus carriers. S. aureus isolates with the SCV phenotype showed significantly higher antibiotic resistance rates than those with the normal phenotype. Patients positive for SCVs were significantly older (P ‫؍‬ 0.0099), more commonly cocolonized with Pseudomonas aeruginosa (P ‫؍‬ 0.0454), and showed signs of more advanced disease, such as lower forced expiratory volume in 1 s (P ‫؍‬ 0.0148) than patients harboring S. aureus with a solely normal phenotype. The logistic regression model determined lower weight (P ‫؍‬ 0.016), advanced age (P ‫؍‬ 0.000), and prior use of trimethoprim-sulfamethoxazole (P ‫؍‬ 0.002) as independent risk factors for S. aureus SCV positivity. The clinical status of CF patients is known to be affected by multiple parameters. Nonetheless, the independent risk factors determined here point to the impact of S. aureus SCVs on chronic and persistent infections in advanced CF lung disease.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Prevalence and Clinical Significance of Staphylococcus aureus Small-Colony Variants in Cystic Fibrosis Lung Disease

Smaczny²,

et al. 2007

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“…SCVs of S. aureus are important in the pathogenesis of a number of chronic forms of staphylococcal infections, including osteomyelitis (424)(425)(426), relapsing prosthetic joint infection (427,428), skin and soft tissue infection (429), endocarditis (430), and infections involving ventriculoperitoneal shunts (431) and nasal sinuses (432). SCVs are also important in patients with cystic fibrosis (CF) (see Pleuropulmonary Infections, below).…”

Section: Osteomyelitismentioning

confidence: 99%

Staphylococcus aureus Infections: Epidemiology, Pathophysiology, Clinical Manifestations, and Management

et al. 2015

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SUMMARY Staphylococcus aureus is a major human pathogen that causes a wide range of clinical infections. It is a leading cause of bacteremia and infective endocarditis as well as osteoarticular, skin and soft tissue, pleuropulmonary, and device-related infections. This review comprehensively covers the epidemiology, pathophysiology, clinical manifestations, and management of each of these clinical entities. The past 2 decades have witnessed two clear shifts in the epidemiology of S. aureus infections: first, a growing number of health care-associated infections, particularly seen in infective endocarditis and prosthetic device infections, and second, an epidemic of community-associated skin and soft tissue infections driven by strains with certain virulence factors and resistance to β-lactam antibiotics. In reviewing the literature to support management strategies for these clinical manifestations, we also highlight the paucity of high-quality evidence for many key clinical questions.

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“…However, the presence of a bacterial subpopulation constituted of small-colony variants (SCVs) is believed to account in part for the increased persistence of the pathogen during chronic or difficult-to-treat infections (1,31,43,48,50). S. aureus SCVs exhibit distinctive phenotypic characteristics on agar, like very small-sized colonies, markedly reduced hemolysin production, and the absence of pigmentation (29).…”

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confidence: 99%

Transcription of Virulence Factors in Staphylococcus aureus Small-Colony Variants Isolated from Cystic Fibrosis Patients Is Influenced by SigB

Moisan¹,

Brouillette²,

Jacob³

et al. 2006

J Bacteriol

146

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Staphylococcus aureus small-colony variants (SCVs) are believed to account in part for the persistence of S. aureus during chronic infections. Little is understood about the gene expression profile that may explain the phenotype and distinguish SCVs from prototype S. aureus strains. In this study, DNA array transcriptional profiles of clinical SCVs isolated from the airways of cystic fibrosis patients were obtained and compared to those obtained from a laboratory-derived SCV strain (i.e., a respiratory-deficient hemB mutant) and prototype S. aureus strains. The genes commonly up-regulated in both hemB and clinical SCVs were found to be implicated in fermentation and glycolysis pathways. The well-known virulence regulator agr was not activated in SCVs, and such strains had low levels of alpha-toxin (hla) gene expression. Clinical SCVs also had a transcriptional signature of their own. Of striking interest is that many genes, most of them under the positive control of the alternate sigma factor SigB, were specifically up-regulated and differed in that way from that seen in prototype S. aureus and the hemB mutant. Since SigB influences up-regulation of adhesin type genes while indirectly down-regulating exoproteins and toxins, we evaluated the internalization and persistence of SCVs in mammalian cells. Results showed that clinical SCVs persisted much more efficiently in cells than the hemB and prototype strains and that a sigB mutant was a poor persister. Thus, it appears that the agr locus plays a minor role in the regulation of the virulon of SCVs, unlike SigB, which may have a key role in intracellular persistence.

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Persistent Wound Infection after Herniotomy Associated with Small-Colony Variants of Staphylococcus aureus

Cited by 57 publications

References 7 publications

Prevalence and Clinical Significance of Staphylococcus aureus Small-Colony Variants in Cystic Fibrosis Lung Disease

Prevalence and Clinical Significance of Staphylococcus aureus Small-Colony Variants in Cystic Fibrosis Lung Disease

Staphylococcus aureus Infections: Epidemiology, Pathophysiology, Clinical Manifestations, and Management

Transcription of Virulence Factors in Staphylococcus aureus Small-Colony Variants Isolated from Cystic Fibrosis Patients Is Influenced by SigB

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