phenylephrine-hydrochloride and Staphylococcal-Skin-Infections

Topics: Anti-Bacterial Agents; Carrier State; Cross Infection; Humans; Infection Control; Methicillin Resistance; Microbial Sensitivity Tests; Nose; Staphylococcal Infections; Staphylococcal Skin Infections; Staphylococcus aureus; Vancomycin Resistance; Wounds and Injuries

Topics: Anti-Bacterial Agents; Drug Resistance, Microbial; Humans; Nose; Recurrence; Staphylococcal Skin Infections; Staphylococcus

Community-associated Staphylococcus aureus infections often affect multiple members of a household. We compared 2 approaches to S. aureus eradication: decolonizing the entire household versus decolonizing the index case alone.. An open-label, randomized trial enrolled 183 pediatric patients (cases) with community-onset S. aureus skin abscesses and colonization of anterior nares, axillae, or inguinal folds from 2008 to 2009 at primary and tertiary centers. Participants were randomized to decolonization of the case alone (index group) or of all household members (household group). The 5-day regimen included hygiene education, twice-daily intranasal mupirocin, and daily chlorhexidine body washes. Colonization of cases and subsequent skin and soft tissue infection (SSTI) in cases and household contacts were ascertained at 1, 3, 6, and 12 months.. Among 147 cases with 1-month colonization data, modified intention-to-treat analysis revealed S. aureus eradication in 50% of cases in the index group and 51% in the household group (P = 1.00). Among 126 cases completing 12-month follow-up, S. aureus was eradicated from 54% of the index group versus 66% of the household group (P = .28). Over 12 months, recurrent SSTI was reported in 72% of cases in the index group and 52% in the household group (P = .02). SSTI incidence in household contacts was significantly lower in the household versus index group during the first 6 months; this trend continued at 12 months.. Household decolonization was not more effective than individual decolonization in eradicating community-associated S. aureus carriage from cases. However, household decolonization reduced the incidence of subsequent SSTI in cases and their household contacts.. NCT00731783.

Topics: Adolescent; Adult; Anti-Bacterial Agents; Anti-Infective Agents, Local; Axilla; Baths; Carrier State; Child; Child, Preschool; Chlorhexidine; Combined Modality Therapy; Community-Acquired Infections; Family Characteristics; Female; Groin; Humans; Infant; Intention to Treat Analysis; Male; Mupirocin; Nose; Patient Compliance; Patient Education as Topic; Soft Tissue Infections; Staphylococcal Skin Infections; Staphylococcus aureus; Young Adult

Despite a paucity of evidence, decolonization measures are prescribed for outpatients with recurrent Staphylococcus aureus skin and soft-tissue infection (SSTI).. Compare the effectiveness of 4 regimens for eradicating S. aureus carriage.. Open-label, randomized controlled trial. Colonization status and recurrent SSTI were ascertained at 1 and 4 months.. Barnes-Jewish and St. Louis Children's Hospitals, St. Louis, Missouri, 2007-2009.. Three hundred patients with community-onset SSTI and S. aureus colonization in the nares, axilla, or inguinal folds.. Participants were randomized to receive no therapeutic intervention (control subjects) or one of three 5-day regimens: 2% mupirocin ointment applied to the nares twice daily, intranasal mupirocin plus daily 4% chlorhexidine body washes, or intranasal mupirocin plus daily dilute bleach water baths.. Among 244 participants with 1-month colonization data, modified intention-to-treat analysis revealed S. aureus eradication in 38% of participants in the education only (control) group, 56% of those in the mupirocin group (P = .03 vs controls), 55% of those in the mupirocin and chlorhexidine group (P = .05), and 63% off those in the mupirocin and bleach group (P = .006). Of 229 participants with 4-month colonization data, eradication rates were 48% in the control group, 56% in the mupirocin only group (P = .40 vs controls), 54% in the mupirocin and chlorhexidine group (P = .51), and 71% in the mupirocin and bleach group (P = .02). At 1 and 4 months, recurrent SSTIs were reported by 20% and 36% of participants, respectively.. An inexpensive regimen of dilute bleach baths, intranasal mupirocin, and hygiene education effectively eradicated S. aureus over a 4-month period. High rates of recurrent SSTI suggest that factors other than endogenous colonization are important determinants of infection. Trial registration. ClinicalTrials.gov identifier: NCT00513799.

Topics: Adolescent; Adult; Anti-Bacterial Agents; Anti-Infective Agents, Local; Baths; Carrier State; Child; Child, Preschool; Chlorhexidine; Combined Modality Therapy; Community-Acquired Infections; Female; Humans; Infant; Male; Mupirocin; Nose; Patient Compliance; Patient Education as Topic; Sodium Hypochlorite; Soft Tissue Infections; Staphylococcal Skin Infections; Staphylococcus aureus; Treatment Outcome; Young Adult

The usefulness of nasal mupirocin in preventing recurrent staphylococcal nasal colonization and skin infection has been examined in immunodeficient patients and in healthy staphylococcal carriers but not in immunocompetent staphylococcal carriers who experience recurrent skin infections. We studied 34 such patients.. After an initial 5-day course of nasal mupirocin ointment for all patients, 17 patients continued to apply a 5-day course of nasal mupirocin every month for 1 year, and the other 17 patients applied a placebo ointment. Nasal cultures were obtained monthly, and all episodes of skin infection were recorded.. The overall number of positive nasal cultures was 22 in the mupirocin group and 83 in the placebo group (P < .001), and the number of skin infections was 26 and 62, respectively (P < .002). Eight of the 17 mupirocin-treated patients but only 2 in the placebo group remained free of positive staphylococcal nasal cultures. One of the 10 patients who were free of colonization during the 12-month treatment period had skin infections, in contrast to all 24 of the patients with positive cultures (P < .01). Staphylococci resistant to mupirocin were observed in 1 patient. No adverse effects were reported.. A monthly application of mupirocin ointment in staphylococcal carriers reduces the incidence of nasal colonization, which in turn lowers the risk of skin infection.

Topics: Administration, Topical; Adolescent; Adult; Carrier State; Child; Double-Blind Method; Female; Humans; Male; Middle Aged; Mupirocin; Nose; Recurrence; Staphylococcal Skin Infections; Staphylococcus aureus; Treatment Outcome

124 stable CAPD patients from 8 Australian and 3 New Zealand centers were randomly assigned in a blinded fashion to one of two groups to study the effect of vaccination using commercial preparations consisting of a combined staphylococcus toxoid and whole killed staphylococci (SB) or normal saline solution (SS) on the incidence of peritonitis and exit site infection and S. aureus nasal carriage over a 12-month prospective period. In addition, levels of IgG, IgA, IgM, C3 and C4 were monitored during the trial period in serum and dialysate; serum levels of anti-alpha hemolysin and dialysate levels of fibronectin and specific antistaphylococcal antibodies were also measured. Over the period, treatment with SB or SS did not affect the incidence of peritonitis, catheter-related infection or S. aureus nasal carriage. However, vaccination with SB elicited a significant increase in the level of serum anti-alpha hemolysin throughout the 12 month duration of the study, although the level of increase was unrelated to the subsequent rate of peritonitis. Vaccination with SB but not SS elicited a significant increase in the dialysate level of specific antibodies against S. aureus. Serum levels of IgG, IgA, IgM, complement C3 and C4 were within the normal range in the CAPD patients studied and remained unaffected by vaccination with SB. In addition, dialysate levels of IgG, IgA, IgM, complement C3 and C4 were 50-100 times lower than corresponding serum levels and remained unaffected by vaccination. In summary, immunisation with an anti-staphylococcal agent was not successful in reducing peritonitis or exit site infection in CAPD patients.

Topics: Catheters, Indwelling; Double-Blind Method; Female; Humans; Male; Middle Aged; Nose; Peritoneal Dialysis, Continuous Ambulatory; Peritonitis; Staphylococcal Infections; Staphylococcal Skin Infections; Staphylococcal Vaccines; Staphylococcus aureus; Vaccination

ST59 is the predominant pathotype of community-associated methicillin-resistant

Topics: Adult; Aged; Alveolar Epithelial Cells; Animals; Bacterial Proteins; Child; Child, Preschool; China; Disease Models, Animal; Female; High-Throughput Nucleotide Sequencing; Humans; Infant; Male; Methicillin-Resistant Staphylococcus aureus; Mice; Middle Aged; Nose; Phylogeny; Sepsis; Staphylococcal Skin Infections; Virulence; Virulence Factors; Whole Genome Sequencing

Examine the relationship between colonization with Staphylococcus aureus in the community and symptomatic infection in two cohorts of Iowans.. Case series within cohort study.. Rural Iowans selected from the Keokuk Rural Health Study, the Agricultural Health Study, and the Iowa Voter Registry.. Longitudinal study within established cohorts evaluating documented S. aureus infections with samples available for molecular typing.. We examined this relationship in two cohorts of Iowans with a combined 11 incident cases of S. aureus SSTI, for which samples were available. Seven of the 11 individuals (63.6%) were colonized at baseline, in the nose (3/7, 42.9%), or in both the nose and throat (57.1%). All seven cases had matching sequence types between colonization and infection isolates.. Staphylococcus aureus causes millions of skin and soft tissue infections yearly. Although colonization with S. aureus is a frequent antecedent to infection, many studies investigating the link between colonization and infection have taken place in a clinical setting, particularly in urban hospitals. Our study has shown similar results in a rural community setting to those previously seen in clinics.

Topics: Adult; Aged; Anti-Bacterial Agents; Carrier State; Community-Acquired Infections; Female; Humans; Iowa; Longitudinal Studies; Male; Methicillin-Resistant Staphylococcus aureus; Middle Aged; Nose; Pharynx; Risk Factors; Rural Population; Skin; Soft Tissue Infections; Staphylococcal Infections; Staphylococcal Skin Infections

The aim of this study was to monitor Staphylococcus aureus colonization and disease severity in adults with atopic dermatitis (AD) during 5 months. Twenty-one patients attended 3 visits each for severity SCORing of Atopic Dermatitis (SCORAD) assessment, quantitative cultures from the skin and conventional cultures from the anterior nares, tonsils and perineum. S. aureus isolates were typed for strain identity with pulsed-field gel electrophoresis (PFGE). Seventy-one percent of patients were colonized with S. aureus on lesional skin at least once. Density (colony-forming units (CFU)/cm2) was higher on lesional skin than on non-lesional skin (p < 0.05). Density on lesional skin and number of colonized body sites were positively correlated with SCORAD (p = 0.0003 and p = 0.007, respectively). Persistent carriers of the same strain on lesional skin had higher mean SCORAD index than intermittent/non-carriers (36.3 and 17.1, respectively, p = 0.002). The results show a temporal correlation between several aspects of S. aureus colonization and disease severity in AD raising the question of the importance of this in pathogenesis and treatment.

Topics: Adult; Aged; Bacterial Load; Colony Count, Microbial; Dermatitis, Atopic; Female; Humans; Male; Middle Aged; Nose; Palatine Tonsil; Perineum; Severity of Illness Index; Skin; Staphylococcal Skin Infections; Staphylococcus aureus; Time Factors

Staphylococcus aureus is a major pathogen causing significant morbidity and mortality worldwide. The emergence of MDR S. aureus strains in the community setting has major implications in disease management. However, data regarding the occurrence and patterns of MDR community-associated S. aureus sub-clones is limited.. To use whole-genome sequences to describe the diversity and distribution of resistance mechanisms among community-associated S. aureus isolates.. S. aureus isolates from skin and soft tissue infections (SSTIs) and nasal colonization were collected from patients within 10 primary care clinics from 2007 to 2015. The Illumina Miseq platform was used to determine the genome sequences for 144 S. aureus isolates. Phylogenetic and bioinformatics analyses were performed using in silico tools. The resistome was assembled and compared with the phenotypically derived antibiogram.. Approximately one-third of S. aureus isolates in the South Texas primary care setting were MDR. A higher proportion of SSTI isolates were MDR in comparison with nasal colonization isolates. Individuals with MDR S. aureus SSTIs were more likely to be African American and obese. Furthermore, S. aureus populations are able to acquire and lose antimicrobial resistance genes. USA300 strains were differentiated by a stable chromosomal mutation in gyrA conferring quinolone resistance. The resistomes were highly predictive of antimicrobial resistance phenotypes.. These findings highlight the high prevalence and epidemiological factors associated with MDR S. aureus strains in the community setting and demonstrate the utility of next-generation sequencing to potentially quicken antimicrobial resistance detection and surveillance for targeted interventions.

Topics: Adult; Anti-Bacterial Agents; Community-Acquired Infections; Drug Resistance, Multiple, Bacterial; Female; Genome, Bacterial; High-Throughput Nucleotide Sequencing; Humans; Male; Methicillin Resistance; Microbial Sensitivity Tests; Middle Aged; Nose; Phylogeny; Prevalence; Soft Tissue Infections; Staphylococcal Infections; Staphylococcal Skin Infections; Staphylococcus aureus; United States; Young Adult

Currently, limited studies have quantified the risk of methicillin-resistant Staphylococcus aureus (MRSA) skin and soft tissue infections (SSTIs) for MRSA-colonized patients on discharge from hospital. Our retrospective, case-control study identified independent risk factors for the development of MRSA SSTIs among such patients detected by active MRSA nasal screening in an acute care hospital by PCR on admission, and bacteriological cultures on discharge. Cases were MRSA-colonized patients aged ⩾18 years who developed a MRSA SSTI post-discharge and controls were those who did not develop a MRSA SSTI post-discharge. Controls were matched to cases by length of follow-up (±10 days) for up to 18 months. Potential demographic and clinical risk factors for MRSA infection were identified using electronic queries and manual chart abstraction; data were compared by standard statistical tests and variables with P values ⩽0·05 in bivariable analysis were entered into a logistic regression model. Multivariable analysis demonstrated prior hospital admission within 12 months (P = 0·02), prior MRSA infection (P = 0·05), and previous myocardial infarction (P = 0·01) were independently predictive of a MRSA SSTI post-discharge. Identification of MRSA colonization upon admission and recognition of risk factors could help identify a high-risk population that could benefit from MRSA SSTI prevention strategies.

Topics: Aged; Carrier State; Case-Control Studies; Female; Hospitals, Veterans; Humans; Male; Methicillin-Resistant Staphylococcus aureus; Middle Aged; Myocardial Infarction; Nose; Patient Admission; Patient Discharge; Retrospective Studies; Risk Factors; Soft Tissue Infections; Staphylococcal Skin Infections

We report the case of a soldier with recurrent skin infection associated with nasal carriage of a Panton-Valentine leukocidin (PVL)-producing methicillin-susceptible Staphylococcus aureus (MSSA), closely related to the EMRSA-15 clone. MSSA isolates causing infection not requiring hospitalization usually go unnoticed; however, their typing may be useful to understand the global distribution of successful staphylococcal lineages related to epidemic clones. PVL-positive MSSA strains might serve as reservoirs from which virulent methicillin-resistant strains may evolve and spread.

Topics: Adult; Bacterial Toxins; Carrier State; Exotoxins; Genotype; Humans; Leukocidins; Male; Military Personnel; Molecular Typing; Nose; Recurrence; Staphylococcal Infections; Staphylococcal Skin Infections; Staphylococcus aureus; Virulence Factors

Staphylococcus aureus is a commensal species that can also be a formidable pathogen. In the United States, an epidemic of community-acquired methicillin-resistant Staphylococcus aureus (MRSA) infections has been occurring for the last 15 years. In the context of a study in which we identified patients with skin and soft tissue infections (SSTIs) and randomized them to receive one of two antimicrobial treatment regimens, we assessed S. aureus colonization in the nares, throat, and perianal skin on the day of enrollment and 40 days after therapy. We compared the prevalence of colonization between the SSTI patients and an uninfected control population. A total of 144 subjects and 130 controls, predominantly African American, participated in this study, and 116 returned for a 40-day follow-up visit. Of the SSTI patients, 76% were colonized with S. aureus at enrollment, as were 65% of the controls. Patients were more likely than the controls to be colonized with USA300 MRSA (62/144 [43.1%] versus 11/130 [8.5%], respectively; P < 0.001). The nares were not the most common site of colonization. The colonization prevalence diminished somewhat after antibiotic treatment but remained high. The isolates that colonized the controls were more likely than those in the patients to be methicillin-susceptible S. aureus (MSSA) (74/84 [88.1%] versus 56/106 [52.8%], respectively; P < 0.001). In conclusion, the prevalence of S. aureus colonization among SSTI patients was high and often involved USA300 MRSA. The prevalence diminished somewhat with antimicrobial therapy but remained high at the 40-day follow-up visit. Control subjects were also colonized at a high prevalence but most often with a genetic background not associated with a clinical infection in this study. S. aureus is a commensal species and a pathogen. Plans for decolonization or eradication should take this distinction into account.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Carrier State; Child; Child, Preschool; Community-Acquired Infections; Emergency Service, Hospital; Female; Humans; Infant; Male; Middle Aged; Nose; Perineum; Prevalence; Skin; Soft Tissue Infections; Staphylococcal Skin Infections; Staphylococcus aureus; Treatment Outcome; United States; Urban Population; Young Adult

In November 2011, The Rockefeller University Center for Clinical and Translational Science (CCTS), the Laboratory of Microbiology and Infectious Diseases, and Clinical Directors Network (CDN) launched a research and learning collaborative project with six community health centers in the New York City metropolitan area to determine the nature (clonal type) of community-acquired Staphylococcus aureus strains causing skin and soft tissue infections (SSTIs). Between November 2011 and March 2013, wound and nasal samples from 129 patients with active SSTIs suspicious for S. aureus were collected and characterized by molecular typing techniques. In 63 of 129 patients, the skin wounds were infected by S. aureus: methicillin-resistant S. aureus (MRSA) was recovered from 39 wounds and methicillin-sensitive S. aureus (MSSA) was recovered from 24. Most-46 of the 63-wound isolates belonged to the CC8/Panton-Valentine leukocidin-positive (PVL(+)) group of S. aureus clone USA300: 34 of these strains were MRSA and 12 were MSSA. Of the 63 patients with S. aureus infections, 30 were also colonized by S. aureus in the nares: 16 of the colonizing isolates were MRSA, and 14 were MSSA, and the majority of the colonizing isolates belonged to the USA300 clonal group. In most cases (70%), the colonizing isolate belonged to the same clonal type as the strain involved with the infection. In three of the patients, the identity of invasive and colonizing MRSA isolates was further documented by whole-genome sequencing.

Topics: Carrier State; Community Health Centers; Community-Acquired Infections; Genetic Variation; Genotype; Humans; Methicillin Resistance; Molecular Epidemiology; Molecular Typing; New York City; Nose; Soft Tissue Infections; Staphylococcal Infections; Staphylococcal Skin Infections; Staphylococcus aureus; Wounds and Injuries

Among athletes, Staphylococcus aureus is thought to be transmitted by close physical contact with carriers. Nevertheless, evidence is limited with regard to both the tracking of individual strains and the role of S. aureus on the skin's surface. We investigated its transmission using molecular genotyping and the presence of S. aureus on the skin during exercise. In the first study, nasal samples were obtained from 172 athletes over a period of up to one year. The 200 strains of S. aureus collected from these athletes were genotyped, and transmission of S. aureus was detected by phage open reading frame typing (POT). In the second study, the presence of S. aureus on the skin's surface was compared between nasal carriers (n=9) and non-nasal carriers (n=9), who had participated in the first study. In the first study, 10 cases of transmission were confirmed. In the second study, exercise-induced sweating increased S. aureus isolates from the skin's surface (before vs. after exercise: 5.2±5.4 vs. 41.7±40.6 CFU/ml) in nasal carriers. In 5 of 9 nasal carriers, S. aureus isolates from the skin's surface were clonally identical to those from the nares. These results identify a major route of S. aureus transmission among athletes and provide insight into the role played by exercise-induced sweating in nasal carriers.

Topics: Carrier State; Genotype; Humans; Nose; Skin; Sports; Staphylococcal Skin Infections; Staphylococcus aureus; Sweating

Topics: Beds; Carrier State; Case-Control Studies; Community-Acquired Infections; Environmental Monitoring; Equipment Contamination; Female; Fomites; Humans; Male; Mouth; New York; Nose; Prisons; Sports Equipment; Staphylococcal Skin Infections; Staphylococcus aureus; Toilet Facilities

In the 1950s an unusually virulent and transmissible penicillin-resistant Staphylococcus aureus clone harbouring Panton-Valentine leukocidin (PVL) genes, known as phage type 80/81 and subsequently identified as multilocus sequence type (ST) 30, emerged and caused serious infections in hospitals and the community. We describe an outbreak of skin infections caused by a PVL-positive, methicillin-susceptible S. aureus (MSSA) strain of ST1472, related to phage type 80/81, in three associated occupational centres. After identification of the first patient an active case-finding strategy was initiated among the three centres. Epidemiological and clinical features were indistinguishable from outbreaks currently caused by community-acquired methicillin-resistant S. aureus. The S. aureus was cultured and identified from nasal swabs and skin lesions by conventional methods; PVL was detected using a PCR assay. Pulsed-field gel electrophoresis and DNA-array-based genotyping were applied to MSSA isolates. MSSA was identified in nasal swabs from 49 of 133 individuals (37%). A single pulsed-field gel electrophoresis pattern, belonging to ST1472 (CC30) and PVL positivity, were detected in 20 individuals, including eight of 18 skin cultures, i.e. 15% of the screened individuals were colonized by the epidemic strain. Nasal and cutaneous decontamination with 5% nasal mupirocin ointment and 2% aqueous chlorhexidine was implemented for all individuals. Patients with active skin infections were treated with a first-generation cephalosporin. General recommendations were made to prevent cross-transmission. No new cases were reported over the following 90 days.

Topics: Adolescent; Adult; Bacterial Toxins; Bacteriophage Typing; Community-Acquired Infections; Disease Outbreaks; Electrophoresis, Gel, Pulsed-Field; Exotoxins; Female; Genotype; Humans; Infection Control; Leukocidins; Male; Methicillin; Microarray Analysis; Middle Aged; Molecular Typing; Nose; Polymerase Chain Reaction; Skin; Spain; Staphylococcal Skin Infections; Staphylococcus aureus; Young Adult

Meticillin-resistant staphylococci are significant pathogens in veterinary dermatology, yet longitudinal studies of the impact of routine antimicrobial therapy on emergence or resolution of resistance are lacking.. To determine the prevalence of meticillin-resistant staphylococci on skin and carriage sites in dogs with bacterial pyoderma and evaluate the prevalence of meticillin-resistant Staphylococcus pseudintermedius (MRSP) colonization after successful treatment of pyoderma.. One hundred and seventy-three dogs that presented to a dermatology referral service with pyoderma and 41 healthy control dogs.. Skin, nasal and rectal swabs for bacterial culture were collected at the time of referral and after clinical resolution of the pyoderma. Meticillin resistance was confirmed by demonstration of penicillin binding protein 2a antigen.. Initially, skin cultures yielded MRSP in 70 (40.5%) dogs, meticillin-resistant Staphylococcus aureus (MRSA) in three (1.7%) and meticillin-resistant Staphylococcus schleiferi ssp. coagulans (MRSScoag) in five (2.9%). Samples collected from the nose and rectum (carriage sites) yielded MRSP in 59 (34.1%) dogs, MRSA in 11 (6.4%) and MRSScoag in seven (4.0%). One hundred and two dogs were available for follow-up cultures after clinical cure. Of 42 dogs initially diagnosed with MRSP pyoderma, MRSP was isolated at follow-up from skin in 19 (45.2%) and carriage sites in 20 (47.6%). Of 60 dogs that did not have MRSP pyoderma initially, MRSP was isolated post-treatment from the skin in 17 (28.3%), and MRSP from carriage sites increased from 7.8% (initially) to 26.7% (P = 0.0022).. Colonization by MRSP often persists after resolution of MRSP pyoderma. Acquisition of MRSP during treatment appears to be common.

Topics: Animals; Carrier State; Dog Diseases; Dogs; Methicillin Resistance; Nose; Pyoderma; Rectum; Skin; Staphylococcal Skin Infections; Staphylococcus

The USA300 methicillin resistant Staphylococcus aureus (MRSA) genetic background has rapidly emerged as the predominant cause of community-associated S. aureus infections in the U.S. However, epidemiologic characteristics of S. aureus household transmission are poorly understood.. We performed a cross-sectional study of adults and children with S. aureus skin infections and their household contacts in Los Angeles and Chicago. Subjects were surveyed for S. aureus colonization of the nares, oropharynx, and inguinal region and risk factors for S. aureus disease. All isolates underwent genetic typing.. We enrolled 1162 persons (350 index patients and 812 household members). The most common infection isolate characteristic was ST8/SCCmec IV, PVL+ MRSA (USA300) (53%). S. aureus colonized 40% (137/350) of index patients and 50% (405/812) of household contacts. A nares-only survey would have missed 48% of S. aureus and 51% of MRSA colonized persons. Sixty-five percent of households had >1 S. aureus genetic background identified and 26% of MRSA isolates in household contacts were discordant with the index patients' infecting MRSA strain type. Factors independently associated (P < .05) with the index strain type colonizing household contacts were recent skin infection, recent cephalexin use, and USA300 genetic background.. In our study population, USA300 MRSA appeared more transmissible among household members compared with other S. aureus genetic backgrounds. Strain distribution was complex; >1 S. aureus genetic background was present in many households. S. aureus decolonization strategies may need to address extra-nasal colonization and the consequences of eradicating S. aureus genetic backgrounds infrequently associated with infection.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Carrier State; Chicago; Child; Child, Preschool; Cross-Sectional Studies; Family Characteristics; Family Health; Female; Humans; Infant; Los Angeles; Male; Methicillin-Resistant Staphylococcus aureus; Middle Aged; Molecular Typing; Nose; Oropharynx; Risk Factors; Staphylococcal Skin Infections

In veterinary medicine, Staphylococcus schleiferi was previously assumed to be an inhabitant of carnivore skin, however, more recently, it has been repeatedly documented in the literature as both an inhabitant and as a pathogen. In order to determine the frequency of nasal carriage, and the methicillin susceptibility pattern of S. schleiferi from healthy dogs as well as dogs with otitis and/or pyoderma, a prospective study including 24 dogs with healthy ears and skin, 27 dogs with healthy ears and pyoderma, 15 dogs with otitis without pyoderma and 20 dogs with both otitis and pyoderma was performed. Specimens were obtained and cultured and isolates were identified as S. schleiferi based on growth and biochemical characteristics. S. schleiferi was isolated from the nares of 1 healthy dog, 3 dogs with recurrent pyoderma, 2 dogs with recurrent otitis, and 1 dog with both recurrent otitis and pyoderma. One of the S. schleiferi isolates was methicillin resistant. Nasal carriage of S. schleiferi does occur in healthy dogs as well as dogs with otitis and pyoderma. Methicillin resistant and sensitive S. schleiferi can be found in the nares of dogs with diseased ears and skin.

Topics: Animals; Anti-Bacterial Agents; Dog Diseases; Dogs; Ear; Methicillin Resistance; Nose; Otitis; Oxacillin; Prospective Studies; Pyoderma; Skin; Staphylococcal Skin Infections; Staphylococcus

We previously found that skin-colonizing Staphylococcus aureus in early childhood atopic dermatitis (AD) originates predominantly from the patient's nose, whereas maternal transmission did not contribute substantially to colonization.. To investigate the transmission route and definitive source of skin-colonizing S aureus in early childhood AD.. A total of 527 children and 32 healthy teachers from 2 kindergartens and 1 elementary school were included in the study. Children were screened for AD and categorized into 3 groups (AD, borderline, and healthy). Samples were collected from 5 to 6 different body sites, including the skin, subungual spaces, and anterior nares. The identity of colonies apparent on mannitol salt agar plates was confirmed by polymerase chain reaction amplification of the nuc gene. The genotypic composition of cultured isolates was examined by pulsed-field gel electrophoresis and analyzed with a dendrogram.. The total colonization rate was higher in the AD group (34.6%) than in the borderline (21.1%) and healthy groups (25.4%). In the AD group, S aureus was more frequently cultured from the subungual areas (30.8%) than the anterior nares (19.2%). To assess self-contamination or recolonization, dendrogram analysis revealed that most isolate pairs (22/23) had the same pulsed-field gel electrophoresis pattern.. As with the anterior nares, the subungual spaces are important reservoir of skin-colonizing S aureus in early childhood AD. The transmission route for self-contamination or recolonization of S aureus appears to be from children's anterior nares to the skin through their own fingers. Child-to-child and/or teacher-to-child transmission in a classroom do not seem to be definite routes of S aureus transmission.

Topics: Bacterial Proteins; Child; Child, Preschool; Dermatitis, Atopic; Electrophoresis, Gel, Pulsed-Field; Faculty; Humans; Micrococcal Nuclease; Nose; Staphylococcal Skin Infections; Staphylococcus aureus

Risks for methicillin-resistant Staphylococcus aureus (MRSA) among those with HIV infection have been found to vary, and the epidemiology of USA-300 community-acquired (CA) MRSA has not been adequately described.. We conducted a retrospective review of HIV-infected out-patients from January 2002 to December 2007 and employed multivariate logistic regression (MLR) to identify risks for MRSA colonization or infection. Pulsed-field gel electrophoresis (PFGE) was used to identify USA-300 strains.. Seventy-two (8%) of 900 HIV-infected patients were colonized or infected with MRSA. MLR identified antibiotic exposure within the past year [odds ratio (OR) 3.4; 95% confidence interval (CI) 1.5-7.7] and nadir CD4 count <200 cells/microL (OR 2.5; 95% CI 1.2-5.3) as risks for MRSA colonization or infection. Receipt of antiretroviral therapy (ART) within the past year was associated with decreased risk (OR 0.16; 95% CI 0.07-0.4). Eighty-nine percent of available strains were USA-300. MLR identified skin or soft tissue infection (SSTI) as the only predictor for infection with USA-300 (OR 5.9; 95% CI 1.4-24.3).. Significant risks for MRSA among HIV-infected patients were CD4 count nadir <200 cells/microL and antibiotic exposure. Only the presence of an SSTI was associated with having USA-300, and thus the use of patient characteristics to predict those with USA-300 was limited. In addition, ART within the previous year significantly reduced the risk of MRSA colonization or infection.

Topics: Adult; Aged; AIDS-Related Opportunistic Infections; Anti-Bacterial Agents; Anti-Retroviral Agents; Carrier State; CD4 Lymphocyte Count; Comorbidity; Electrophoresis, Gel, Pulsed-Field; Epidemiologic Methods; Female; Humans; Male; Methicillin-Resistant Staphylococcus aureus; Microbial Sensitivity Tests; Middle Aged; Nose; Outpatients; Soft Tissue Infections; Staphylococcal Skin Infections; Viral Load; Young Adult

This prospective study was designed to evaluate predictors of skin and soft tissue infections (SSTI) due to community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA). Consecutive patients who were hospitalized with S aureus SSTI were enrolled. CA-MRSA infection was diagnosed in 76% of the children. MRSA SSTI was associated with black race (P = .0001) and with infection involving the lower trunk (P = .008). Only 21% of the patients in this study had S aureus colonization in their nares, and in 3 cases there was discordance between the nares and the infection site cultures. Sensitivity, specificity, and predictive values of the risk factors examined were limited in their ability to predict CA-MRSA infection. Given the high prevalence of MRSA in our community and the inability of nasal cultures to reliably predict CA-MRSA infection, empirical antibiotic therapy active against CA-MRSA and contact isolation of patients are recommended.

Topics: Age Distribution; Anti-Bacterial Agents; Blood; Cohort Studies; Community-Acquired Infections; Cross Infection; Female; Hospitals, Pediatric; Humans; Logistic Models; Male; Methicillin-Resistant Staphylococcus aureus; Microbial Sensitivity Tests; Multivariate Analysis; Nose; Predictive Value of Tests; Prevalence; Prospective Studies; Risk Assessment; Sensitivity and Specificity; Severity of Illness Index; Sex Distribution; Soft Tissue Infections; Staphylococcal Skin Infections; Statistics, Nonparametric; Treatment Outcome

The goal was to compare rectal and nasal Staphylococcus aureus colonization rates and S aureus pulsed-field types (PFTs) for children with S aureus skin and soft-tissue abscesses and normal control subjects.. Sixty consecutive children with S aureus skin and soft-tissue abscesses that required surgical drainage and 90 control subjects were enrolled. Cultures of the nares and rectum were taken in both groups. S aureus isolates from all sites were characterized through multiple-locus, variable-number, tandem-repeat analysis, pulsed-field gel electrophoresis, staphylococcal cassette chromosome mec typing for methicillin-resistant S aureus isolates, and determination of the presence of Panton-Valentine leukocidin genes.. S aureus was detected significantly more often in the rectum of children with abscesses (47%) compared with those in the control group (1%; P = .0001). Rates of nasal colonization with S aureus were equivalent for children with abscesses (27%) and control subjects (20%; P = .33). S aureus recovered from the rectum was identical to S aureus in the abscess in 88% of cases, compared with 75% of nasal isolates. PFT USA300, staphylococcal cassette chromosome mec type IV, and Panton-Valentine leukocidin genes were significantly increased in the S aureus isolates from children with abscesses compared with those from control subjects.. Skin and soft-tissue abscesses in the current epidemic of community-associated staphylococcal disease are strongly associated with rectal colonization by PFT USA300. Nasal colonization in children does not seem to be a risk factor.

Topics: Abscess; Child; Child, Preschool; Female; Humans; Infant; Male; Nose; Rectum; Staphylococcal Skin Infections

Staphylococcus aureus is a major cause of skin and soft tissue infections, such as furuncles, carbuncles, and abscesses, but it also frequently colonizes the human skin and mucosa without causing clinical symptoms. Panton-Valentine leukocidin (PVL) is a pore-forming toxin that has been associated with soft tissue infections and necrotizing pneumonia. We have compared the genotypes, virulence gene repertoires, and phage patterns of 74 furunculosis isolates with those of 108 control strains from healthy nasal carriers. The large majority of furunculosis strains were methicillin sensitive. Clonal cluster (CC) 121 (CC121) and CC22 accounted for 70% of the furunculosis strains but for only 8% of the nasal isolates. The PVL-encoding genes luk-PV were detected in 85% of furunculosis strains, while their prevalence among colonizing S. aureus strains was below 1%. luk-PV genes were distributed over several lineages (CCs 5, 8, 22, 30, and 121 and sequence type 59). Even within the same lineages, luk-PV-positive phages characterized furunculosis strains, while their luk-PV-negative variants were frequent among nasal strains. The very tight epidemiological linkage between luk-PV and furunculosis, which could be separated from the genetic background of the S. aureus strain as well as from the gene makeup of the luk-PV-transducing phage, lends support to the notion of an important role for PVL in human furunculosis. These results make a case for the determination of luk-PV in recurrent soft tissue infections with methicillin-sensitive as well as methicillin-resistant S. aureus.

Topics: Adolescent; Adult; Bacterial Proteins; Bacterial Toxins; Bacteriophage Typing; Carrier State; Cluster Analysis; DNA, Bacterial; Exotoxins; Female; Furunculosis; Genotype; Humans; Leukocidins; Male; Nose; Recurrence; Staphylococcal Skin Infections; Staphylococcus aureus; Virulence Factors; Young Adult

To determine the frequency and clinical importance of methicillin-resistant Staphylococcus aureus (MRSA) colonization in student athletes.. Prospective observational cohort study.. A major university in the southeastern United States.. Student athletes participating in the men's football and women's lacrosse programs (N = 126). Main Exposure Monthly assessment of S aureus nasal colonization.. Trends in S aureus colonization over time and the occurrence of skin and soft tissue infections.. Methicillin-resistant S aureus nasal colonization varied significantly through the athletic season (4%-23%), peaking during times of highest athletic activity. This increase in colonization was not associated with the development of an outbreak of skin and soft tissue infections, and no single MRSA clone emerged as a dominant isolate.. During the athletic season, there is a considerable burden of MRSA colonization in student athletes; however, colonization alone appears to be insufficient to trigger an outbreak of staphylococcal infections. A combination of distinct molecular characteristics in the organism and specific host factors may govern the development of staphylococcal disease.

Topics: Adolescent; Adult; Athletes; Female; Football; Humans; Male; Methicillin-Resistant Staphylococcus aureus; Nose; Prospidium; Racquet Sports; Sports; Staphylococcal Infections; Staphylococcal Skin Infections

Topics: Administration, Inhalation; Administration, Oral; Anti-Bacterial Agents; Anti-Infective Agents, Local; Carrier State; Humans; Methicillin-Resistant Staphylococcus aureus; Nose; Perineum; Pharynx; Recurrence; Soft Tissue Infections; Staphylococcal Skin Infections

Methicillin-resistant Staphylococcus aureus (MRSA) has emerged as an important cause of skin and soft-tissue infections (SSTI). The understanding of the molecular epidemiology and virulence of MRSA continues to expand. From January 2005 to December 2005, we screened soldiers for MRSA nasal colonization, administered a demographic questionnaire, and monitored them prospectively for SSTI. All MRSA isolates underwent molecular analysis, which included pulsed-filed gel electrophoresis (PFGE) and PCR for Panton-Valentine leukocidin (PVL), the arginine catabolic mobile element (ACME), and the staphylococcal cassette chromosome mec (SCCmec). Of the 3,447 soldiers screened, 134 (3.9%) had MRSA colonization. Of the 3,066 (89%) who completed the study, 39 developed culture-confirmed MRSA abscesses. Clone USA300 represented 53% of colonizing isolates but was responsible for 97% of the abscesses (P < 0.001). Unlike colonizing isolates, isolates positive for USA300, PVL, ACME, and type IV SCCmec were significantly associated with MRSA abscess isolates. As determined by multivariate analysis, risk factors for MRSA colonization were a history of SSTI and a history of hospitalization. Although various MRSA strains may colonize soldiers, USA300 is the most virulent when evaluated prospectively, and PVL, ACME, and type IV SCCmec are associated with these abscesses.

Topics: Abscess; Bacterial Toxins; Carrier State; DNA Fingerprinting; DNA, Bacterial; Electrophoresis, Gel, Pulsed-Field; Exotoxins; Genotype; Humans; Leukocidins; Methicillin-Resistant Staphylococcus aureus; Military Personnel; Molecular Epidemiology; Nose; Risk Factors; Staphylococcal Infections; Staphylococcal Skin Infections; Surveys and Questionnaires; Virulence Factors

Surgical-site infections (SSI), because of MRSA, are a challenge for acute care hospitals. The current study examines the impact of best practices and active surveillance screening for MRSA on reduction of MRSA SSIs.. Beginning February 2007, all admissions to a 761-bed tertiary care hospital were screened for MRSA by nasal swab using polymerase chain reaction-based testing. Positive nasal carriers of MRSA were treated before operation. The subset of patients undergoing procedures that are part of the Surgical Infection Prevention Project were followed for MRSA SSIs. SSI rates (per 100 procedures) were determined using the National Nosocomial Infection Surveillance definitions. MRSA SSI rates were compared before and after the MRSA screening intervention. Differences were analyzed using Fisher's exact test and chi-square with Yate's continuity correction. Where specimens were available, genotyping of MRSA was performed using a commercially available assay.. After universal MRSA surveillance, 5,094 patients underwent Surgical Infection Prevention Project procedures. The rate of MRSA SSI decreased from 0.23% to 0.09%. The reduction was most pronounced in joint-replacement procedures (0.30% to 0%; p = 0.04). No other differences were statistically significant. Of the seven patients in whom MRSA SSI developed after universal screening, four had positive MRSA screens; none had received preoperative eradication of MRSA. In two of these patients, the genotype of MRSA detected on screening and in SSI was genetically indistinguishable.. Surveillance for MRSA and eradication of the carrier state reduces the rate of MRSA SSI.

Topics: Arthroplasty, Replacement; Benchmarking; Carrier State; Cross Infection; Female; Humans; Male; Mass Screening; Methicillin-Resistant Staphylococcus aureus; Middle Aged; North Carolina; Nose; Population Surveillance; Staphylococcal Skin Infections; Surgery Department, Hospital; Surgical Wound Infection

Staphylococcus aureus skin colonization in atopic dermatitis (AD) patients exacerbates disease activity. Nasal and throat S. aureus carriage may be also implicated in the clinical course of allergic rhinitis and asthma. The aim of the study was to evaluate the frequency of skin, nasal, throat S. aureus colonization in patients with AD and asthma and assess if presence of this bacteria on the skin may be related with degree of sensitization.. Swabs for microbiological analysis were taken from affected skin, anterior nares and throat from 40 children with AD, 59 children with asthma and 56 healthy controls. Following lymphocyte subsets: CD3+, CD4+, CD8+, CD3+CD25+, CD4+CD25+ were measured using flow cytometry.. Nasal and throat S. aureus colonization was more frequent in atopic children. S. aureus was found in the skin lesions in 97.5% examined children with AD. Percentage of CD8+ was decreased but the number of CD4+, and CD4+CD25T+ cells was elevated compared with healthy. Total IgE and sIgE Der. pteronyssinus and Der. farinae as well SPT (Skin Prick Test) wheel size were higher in AD children compared to asthma. SCORAD was correlated with total and sIgE (mite, pollen) and number of S. aureus and increasing skin reactivity skin. The degree of sensitization was correlated with patient's age, duration of AD and asthma and number of CD3+, CD4+ and percentage of CD4+CD25+ only in AD patients. Severity of asthma was correlated with FEV1 and total IgE.. Staphylococcus aureus skin colonization in AD children increases disease activity and degree of sensitization measured by SPT wheel size and results in imbalance of peripheral blood T cells.

Topics: Asthma; Child; Dermatitis, Atopic; Female; Humans; Immunoglobulin E; Lymphocyte Subsets; Male; Nose; Pharynx; Rhinitis; Skin; Skin Tests; Staphylococcal Skin Infections; Staphylococcus aureus

This territory-wide study evaluated the molecular epidemiology of methicillin-resistant Staphylococcus aureus (MRSA) in residential care homes for elderly (RCHEs) in Hong Kong. MRSA colonization was assessed by taking swab culture from anterior nares and active skin lesions. Of 487 RCHEs surveyed, 80 MRSA strains were recovered from 1563 residents, giving a prevalence of 5.1%. Twenty-four isolates had SCCmec II, 2 had SCCmec III, 17 had SCCmec IV, 36 had SCCmec V, and 1 had a composite SCCmec type. Pulsed-field gel electrophoresis typing clustered 75 isolates into 7 clones (HKU10 to 50, HKU80, and HKU90). Two predominant types, HKU30 and HKU50, which together account for 75% of all MRSA strains, were found in 13 and 15 of the 18 geographic districts in Hong Kong, respectively. The main features for HKU50 strains were spa t1081/ST45-IV or V, capsular type 8, agrIV, and hla, seg, sei positive. On the other hand, HKU30 strains had spa t002/ST5-II, capsular type 5, agrII, and were hla, seg, sei positive. HKU30 strains were often multidrug resistant (MDR, involving ciprofloxacin, erythromycin, gentamicin, and tetracycline). In contrast, HKU50 strains exhibit both multidrug resistance (MDR) (involving ciprofloxacin, erythromycin, and tetracycline, but not gentamicin) and non-MDR patterns.

Topics: Aged; Aged, 80 and over; Anti-Bacterial Agents; Carrier State; Cluster Analysis; Cross Infection; DNA Fingerprinting; DNA, Bacterial; Drug Resistance, Multiple, Bacterial; Electrophoresis, Gel, Pulsed-Field; Genes, Bacterial; Hong Kong; Humans; Methicillin Resistance; Molecular Epidemiology; Nose; Prevalence; Staphylococcal Skin Infections; Staphylococcus aureus

Rapid and reliable detection of methicillin-resistant Staphylococcus aureus (MRSA) carriers is crucial for the effective control of MRSA transmission in healthcare facilities. The aim of this study was to verify the performance of the IDI-MRSA real-time PCR assay for direct MRSA detection in diverse mucocutaneous swabs from hospitalized patients. Swabs from nares (n = 522) and skin or other superficial sites (n = 478) were prospectively collected for MRSA screening from 466 patients admitted to an 858-bed teaching hospital. Swabs were inoculated onto selective chromogenic MRSA-ID agar, buffer extraction solution for IDI-MRSA assay, and enrichment broth. MRSA was detected by culture in 100 specimens from 47 patients. Compared to enrichment culture, the sensitivity and specificity of the PCR assay were 81.0 and 97.0%, respectively, and its positive and negative predictive values were 75.0 and 97.9%, respectively. The IDI-MRSA assay was more sensitive on swabs from nares (90.6%) than from other body sites (76.5%, P < 0.01). The PCR assay detected MRSA in 42 of 47 patients with culture positive study samples. Of 26 patients with culture-negative but PCR-positive study samples, 11 were probable true MRSA carriers based on patient history and/or positive culture on a new sample. The median turnaround time for PCR results was 19 h versus 3 days for agar culture results and 6 days for enrichment culture results. These data confirm the value of IDI-MRSA assay for rapid screening of MRSA mucocutaneous carriage among hospitalized patients. Cost-effectiveness studies are warranted to evaluate the impact of this assay on infection control procedures in healthcare settings.

Topics: Bacteriological Techniques; Carrier State; Culture Techniques; Hospitals, University; Humans; Methicillin Resistance; Nose; Polymerase Chain Reaction; Predictive Value of Tests; Prospective Studies; Sensitivity and Specificity; Skin; Staphylococcal Infections; Staphylococcal Skin Infections; Staphylococcus aureus; Time Factors

Methicillin-resistant Staphylococcus aureus (MRSA) is an increasing problem. Rapid detection of MRSA-colonized patients has the potential to limit spread of the organism. We evaluated the sensitivities and specificities of MRSA detection by two molecular methods (IDI-MRSA PCR assay and GenoType MRSA Direct PCR assay) and three selective MRSA agars (MRSA ID, MRSASelect, and CHROMagar MRSA), using 205 (101 nasal, 52 groin, and 52 axillary samples) samples from consecutive known MRSA-infected and/or -colonized patients. All detection methods had higher MRSA detection rates for nasal swabs than for axillary and groin swabs. Detection of MRSA by IDI-MRSA was the most sensitive method, independent of the site (94% for nasal samples, 80% for nonnasal samples, and 90% overall). The sensitivities of the GenoType MRSA Direct assay and the MRSA ID, MRSASelect, and CHROMagar MRSA agars with nasal swabs were 70%, 72%, 68%, and 75%, respectively. All detection methods had high specificities (95 to 99%), independent of the swab site. Extended incubation for a further 24 h with selective MRSA agars increased the detection of MRSA, with a corresponding decline in specificity secondary to a significant increase in false-positive results. There was a noticeable difference in test performance of the GenoType MRSA Direct assay in detection of MRSA (28/38 samples [74%]) compared with detection of nonmultiresistant MRSA (17/31 samples [55%]) (susceptible to two or more non-beta-lactam antibiotics). This was not observed with selective MRSA agar plates or IDI-MRSA. Although it is more expensive, in addition to rapid turnaround times of 2 to 4 h, IDI-MRSA offers greater detection of MRSA colonization, independent of the swab site, than do conventional selective agars and GenoType MRSA Direct.

Topics: Axilla; Bacteriological Techniques; Carrier State; Groin; Humans; Methicillin Resistance; Nose; Polymerase Chain Reaction; Sensitivity and Specificity; Staphylococcal Skin Infections; Staphylococcus aureus

The aim of the study was to investigate the rate of Staphylococcus aureus nasal and skin carriage in patients undergoing haemodialysis. The cultured staphylococcal isolates were subsequently characterized by molecular methods. The study group comprised 43 haemodialysed patients from whom nasal and skin swabs from the vascular access sites were collected. The identification of staphylococcal isolates and antibiotic susceptibility testing were performed on the basis of conventional diagnostic procedures. The staphylococci were further characterized using Pulsed-Field Gel Electrophoresis (PFGE). S. aureus was cultured from 12 (27.9%) patients. Only one (8.3%) patient was colonized with the microorganism both in the anterior nares and the vascular access site representing a single strain, as evidenced by PFGE analysis. Antibiotic susceptibility testing identified one (7.6%) methicillin-resistant S. aureus (MRSA) strain. PFGE typing identified several S. aureus genotypes with the lack of one specific strain responsible for colonization. However, it should be noted that among two (A and D) PFGE patterns genetically indistinguishable and closely related isolates (two isolates for each pattern) were identified. The obtained results revealed a relatively low rate of S. aureus carriage accompanied by low methicillin resistance rate and a significant genetic diversity of cultured isolates with the lack of one predominant strain responsible for colonization.

Topics: Adult; Aged; Anti-Bacterial Agents; Bacterial Typing Techniques; Carrier State; DNA Fingerprinting; DNA, Bacterial; Electrophoresis, Gel, Pulsed-Field; Genetic Variation; Genotype; Humans; Methicillin Resistance; Microbial Sensitivity Tests; Middle Aged; Nose; Nose Diseases; Prevalence; Renal Dialysis; Renal Insufficiency; Staphylococcal Infections; Staphylococcal Skin Infections; Staphylococcus aureus

To evaluate the prevalence of colonization among patients with community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) infection and their household contacts.. Prospective, observational laboratory study of nasal colonization among patients and their household members from September 15, 2004, to February 20, 2006.. A 600-bed, urban, academic medical center.. Fifty-one patients who presented with CA-MRSA infections and 49 household members had cultures of nasal swab specimens performed.. Skin and soft-tissue infections were seen in 50 patients (98%) and 2 household members. Twenty-one (41%) of 51 patients and 10 (20%) of 49 household members were colonized with MRSA. An additional 5 patients (10%) and 12 household members (24%) were colonized with methicillin-susceptible Staphylococcus aureus. Most MRSA isolates (95%; infective and colonizing) carried the staphylococcal cassette chromosome mec type IV complex, and 67% represented a single clone, identical to USA 300. Of the colonized household members, 5 had isolates related to the patients' infective isolate.. The frequency of CA-MRSA colonization among household members of patients with CA-MRSA infections is higher than rates reported among the general population. Among colonized household members, only half of the MRSA strains were related to the patients' infective isolate. Within the same household, multiple strains of CA-MRSA may be present.

Topics: Adult; Community-Acquired Infections; Family Characteristics; Female; Humans; Male; Methicillin Resistance; Michigan; Middle Aged; Nose; Prevalence; Prospective Studies; Staphylococcal Infections; Staphylococcal Skin Infections; Staphylococcus aureus

The present study was designed to evaluate the usefulness of two novel molecular typing methods, amplification of DNA fragments surrounding rare restriction sites (ADSRRS-fingerprinting) and the PCR melting profile (PCR MP), for Staphylococcus aureus strain differentiation. Thirty-seven S. aureus strains isolated from patients with a history of furunculosis were studied. The strains were identified by determining several phenotypic properties and were genotyped using three differentiation methods: macrorestriction analysis of the chromosomal DNA by pulsed-field gel electrophoresis (REA-PFGE), ADSRRS-fingerprinting, and PCR MP technique. In some cases the results obtained showed that the S. aureus isolated from the nose was identical to the one from the furuncle of the same patient. The same genotype was also identified for S. aureus strains isolated from two different members of a family with a history of recurrent furunculosis, although the active lesions were present in only one of them when the investigation was done. Results from strain genotyping illustrated that the recently developed ADSRRS-fingerprinting and PCR MP techniques are useful for studies of intraspecies genetic relatedness of S. aureus strains. They are as effective in discriminating closely related strains as the PFGE method, which is currently considered to be "the gold standard" for epidemiological studies.

Topics: Bacterial Typing Techniques; Child, Preschool; Cluster Analysis; DNA Fingerprinting; DNA, Bacterial; Electrophoresis, Gel, Pulsed-Field; Family Health; Furunculosis; Genotype; Humans; Infant; Molecular Epidemiology; Nose; Polymerase Chain Reaction; Polymorphism, Restriction Fragment Length; Prohibitins; Staphylococcal Skin Infections; Staphylococcus aureus; Transition Temperature

To compare the frequency of detection of Staphylococcus aureus carrier state in anterior nares of the patients suffering from recurrent furunculosis with the normal population and to determine the efficacy of rifampicin in eradication of the carrier state.. Quasi-experimental study.. Skin Department of Combined Military Hospital, Peshawar and Multan, from March 2004 to December 2005.. The study consisted of 80 individuals. They were placed in two groups. Group I comprised of 40 patients suffering from recurrent furuncles and group II included 40 healthy adults, kept as controls. Nasal swab was taken from the individuals belonging to both the groups, when they first reported to skin OPD. The patients who were suffering from furuncles were treated with co-amoxiclav 375 or 625 mg three times a day. The patients in whom S. aureus carrier state was detected were again divided into two groups. Group 1 was prescribed rifampicin 450-600 mg daily (depending on the body weight) for 10 days, while the group 2 was not offered any treatment. After this course, a second nasal swab was taken and submitted for cultures.. Among the 40 patients belonging to group I, S. aureus carrier state was detected in 23 (57.5%), while in group II the carrier state was found in 8 (20%) individuals (p<0.001). Among the 13 patients who received rifampicin, 10 got cured of carrier state, while in 3 patients nasal swab was still positive after a course of rifampicin. In 10 patients, who were not offered any treatment, the nasal swabs remained positive (p<0.001). These patients were followed-up in skin OPD for another 3 months, and did not develop any recurrence of the infection.. Nasal swab for detection of S. aureus carrier state should be done in all patients of recurrent furunculosis. If the nasal swab culture is positive, then as the infection gets cured, the patients should receive a course of rifampicin for 10 days. This may eradicate the carrier state in majority of cases and prevent the recurrence of the infection.

Topics: Adolescent; Adult; Carrier State; Female; Furunculosis; Humans; Male; Middle Aged; Nose; Recurrence; Rifampin; Staphylococcal Skin Infections

Methicillin-resistant Staphylococcus aureus (MRSA) is an emerging cause of infections outside of health care settings. We investigated an outbreak of abscesses due to MRSA among members of a professional football team and examined the transmission and microbiologic characteristics of the outbreak strain.. We conducted a retrospective cohort study and nasal-swab survey of 84 St. Louis Rams football players and staff members. S. aureus recovered from wound, nasal, and environmental cultures was analyzed by means of pulsed-field gel electrophoresis (PFGE) and typing for resistance and toxin genes. MRSA from the team was compared with other community isolates and hospital isolates.. During the 2003 football season, eight MRSA infections occurred among 5 of the 58 Rams players (9 percent); all of the infections developed at turf-abrasion sites. MRSA infection was significantly associated with the lineman or linebacker position and a higher body-mass index. No MRSA was found in nasal or environmental samples; however, methicillin-susceptible S. aureus was recovered from whirlpools and taping gel and from 35 of the 84 nasal swabs from players and staff members (42 percent). MRSA from a competing football team and from other community clusters and sporadic cases had PFGE patterns that were indistinguishable from those of the Rams' MRSA; all carried the gene for Panton-Valentine leukocidin and the gene complex for staphylococcal-cassette-chromosome mec type IVa resistance (clone USA300-0114).. We describe a highly conserved, community-associated MRSA clone that caused abscesses among professional football players and that was indistinguishable from isolates from various other regions of the United States.

Topics: Abscess; Adult; Clone Cells; Cohort Studies; Community-Acquired Infections; Disease Outbreaks; Electrophoresis, Gel, Pulsed-Field; Football; Gels; Humans; Hydrotherapy; Male; Methicillin Resistance; Microbial Sensitivity Tests; Nose; Retrospective Studies; Risk Factors; Skin; Staphylococcal Infections; Staphylococcal Skin Infections; Staphylococcus aureus; United States

We sought to determine the prevalence of methicillin-resistant Staphylococcus aureus (MRSA) among emergency department (ED) patients with skin and soft tissue infections, identify demographic and clinical variables associated with MRSA, and characterize MRSA by antimicrobial susceptibility and genotype.. This was a prospective observational study involving a convenience sample of patients who presented with skin and soft tissue infections to a single urban public hospital ED in California. Nares and infection site cultures were obtained. A health and lifestyle questionnaire was administered, and predictor variables independently associated with MRSA were determined by multivariate logistic regression. All S aureus isolates underwent antibiotic susceptibility testing. Eighty-five MRSA isolates underwent genotyping by pulsed field gel electrophoresis, staphylococcal chromosomal cassette mec (SCC mec ) typing, and testing for Panton-Valentine leukocidin genes.. Of 137 subjects, 18% were homeless, 28% injected illicit drugs, 63% presented with a deep or superficial abscess, and 26% required admission for the infection. MRSA was present in 51% of infection site cultures. Of 119 S aureus isolates (from infection site and nares), 89 (75%) were MRSA. Antimicrobial susceptibility among MRSA isolates was trimethoprim/sulfamethoxazole 100%, clindamycin 94%, tetracycline 86%, and levofloxacin 57%. Among predictor variables independently associated with MRSA infection, the strongest was infection type being furuncle (odds ratio 28.6). Seventy-six percent of MRSA cases fit the clinical definition of community associated. Ninety-nine percent of MRSA isolates possessed the SCC mec IV allele (typical of community-associated MRSA), 94.1% possessed Panton-Valentine leukocidin genes, and 87.1% belonged to a single clonal group (ST8:S).. In this urban ED population, MRSA is a major pathogen in skin and soft tissue infections. Although studies from other practice settings are needed, MRSA should be considered when empiric antibiotic therapy is selected for such infections.

Topics: Adolescent; Adult; California; Carrier State; Community-Acquired Infections; Emergency Service, Hospital; Female; Furunculosis; Genotype; Humans; Logistic Models; Male; Methicillin Resistance; Microbial Sensitivity Tests; Middle Aged; Nose; Odds Ratio; Prevalence; Prospective Studies; Soft Tissue Infections; Staphylococcal Infections; Staphylococcal Skin Infections; Staphylococcus aureus; Urban Health

Staphylococcus aureus has important implications for the pathogenesis of atopic dermatitis (AD). In some patients S. aureus can be eradicated from the skin during anti-inflammatory treatment, while in others bacterial colonization is persistent. Potential mechanisms and features of these two distinct groups of patients are not known.. Accordingly, we studied relationships between the ability to eliminate S. aureus during an anti-inflammatory treatment and selected clinical and immunological features.. Quantitative assessment of S. aureus on the skin, in nasal vestibule and throat, serum IgE levels, CD4/CD8 T-cell ratio, lymphocyte proliferation and phagocyte oxidative burst were determined during the exacerbation and after 4 and 12 weeks of the treatment using topical steroid and oral antihistamine in 34 patients with AD.. S. aureus was found on the skin of all 34 patients during exacerbation. Disease severity scoring of atopic dermatitis (SCORAD) correlated with the density of bacteria. Treatment with oral antihistamine and topical steroid resulted in a significant alleviation of symptoms, which correlated with the elimination of S. aureus from the skin in 70% of patients. In the remaining 30% of patients, dense (more than 10(10)/cm2) S. aureus skin colonization, persisted despite the treatment. Patients with persistent S. aureus presented with higher serum IgE levels, lower lymphocyte proliferation in response to staphylococcal enterotoxin B, phytohaemagluttinin and anti-CD3. Persistence of S. aureus was more common in men.. Patients with AD differ in the ability to clear S. aureus from the skin during anti-inflammatory treatment, which appears to be related to the abnormalities in immunological parameters. Local antibiotic therapy should be considered only in patients with persistent S. aureus colonization.

Topics: Administration, Topical; Adult; Anti-Allergic Agents; CD4-CD8 Ratio; Cetirizine; Dermatitis, Atopic; Female; Histamine H1 Antagonists, Non-Sedating; Humans; Immunoglobulin E; Male; Mometasone Furoate; Nose; Pharynx; Pregnadienediols; Skin; Staphylococcal Skin Infections; Staphylococcus aureus

Between 1 February and 15 April 2002, 95 patients were admitted to Gaston Bourret Territorial Hospital (New Caledonia, France) for drainage of community-acquired soft tissue abscesses. Staphylococcus aureus was detected in 68 cases (72%). Two-thirds of the patients with S. aureus infection had furuncles, which were located on the limbs in 82% of cases. The median interval between symptom onset and hospital admission was 5.7 days. Three-quarters of the patients were Melanesians living in tribes. Fifty-four S. aureus isolates were screened for toxin genes. Panton-Valentine leucocidin (PVL) genes were detected in 48 isolates (89%), the exfoliative toxin A gene was detected in 1 isolate, and no toxin genes were detected in 4 isolates. S. aureus nasal carriage was detected in 39.7% of patients with S. aureus infections. Two infecting S. aureus strains and two nasal carriage strains were resistant to methicillin. Comparative pulsed-field gel electrophoresis, performed in 16 cases, showed that five of six patients with PVL-positive nasal carriage strains were infected by the same strains. In contrast, 8 of 10 patients with PVL-negative nasal carriage strains were infected by PVL-positive strains. PVL genes thus appear to be a major virulence factor in both primary and secondary S. aureus skin infections.

Topics: Abscess; Adult; Bacterial Toxins; Carrier State; Community-Acquired Infections; Exotoxins; Female; Humans; Leukocidins; Male; Nose; Soft Tissue Infections; Staphylococcal Skin Infections; Staphylococcus aureus

Topics: Bacteremia; Carrier State; Humans; Methicillin Resistance; Nose; Skin; Staphylococcal Infections; Staphylococcal Skin Infections; Staphylococcus aureus

The present study was designed to investigate the significance and the relationship between nasal carriage of Staphylococcus aureus and staphylococcal skin infections. Thirty-one S. aureus strains, isolated from 12 patients with chronic and recurrent skin infections, one patient with septicemia and one patient with otitis externa were studied. The staphylococcal strains were isolated from the site of infection and from the anterior nares of each patient. The identity of both strains of each pair could be demonstrated by determination of phenotypic properties and by genotyping of the isolates. The phenotypic properties included hemolytic activities, antibiotic resistance data, and the production of enterotoxins. The identity was additionally confirmed by phage-typing, by determination of the size and the number of repeats of the X region of spa gene, by determination of gene polymorphisms of coa gene and by macrorestriction analysis of the chromosomal DNA of the isolates by pulsed-field gel electrophoresis. The present results showed an identity of the S. aureus obtained from anterior nares and from skin infection of each patient indicating the importance of nasal carriage of these bacteria for development of human skin infection.

Topics: Bacteriophage Typing; Carrier State; Chronic Disease; Disease Susceptibility; Electrophoresis, Gel, Pulsed-Field; Enterotoxins; Genes, Bacterial; Genotype; Humans; Microbial Sensitivity Tests; Nose; Otitis; Polymerase Chain Reaction; Polymorphism, Genetic; Restriction Mapping; Skin; Staphylococcal Skin Infections; Staphylococcus aureus

Nasal carriage of Staphylococcus aureus is common among health care workers, but outbreaks caused by such carriers are relatively uncommon. We previously reported outbreaks of S. aureus skin infections that affected newborn infants and were attributed to an S. aureus nasal carrier who had had an associated upper respiratory tract infection (UR) during the outbreak period.. To investigate the contribution of a nasal methicillin-resistant S. aureus (MRSA) carrier (physician 4) who contracted a URI to an outbreak of MRSA infections that involved 8 of 43 patients in a surgical intensive care unit during a 3-week period.. An epidemiologic study of an outbreak of MRSA infections and a quantitative investigation of airborne dispersal of S. aureus associated with an experimentally induced rhinoviral infection.. A university hospital.. 43 patients in a surgical intensive care unit and 1 physician.. Molecular typing was done, and risk factors for MRSA colonization were analyzed. Agar settle plates and volumeric air cultures were used to evaluate the airborne dispersal of S. aureus by physician 4 before and after a rhinoviral infection and with or without a surgical mask.. A search for nasal carriers of MRSA identified a single physician (physician 4); molecular typing showed that the MRSA strain from physician 4 and those from the patients were identical. Multivariate logistic regression analysis identified exposure to physician 4 and duration of ventilation as independent risk factors for colonization with MRSA (P < or = 0.008). Air cultures showed that physician 4 dispersed little S. aureus in the absence of a URI. After experimental induction of a rhinovirus URI, physician 4's airborne dispersal of S. aureus without a surgical mask increased 40- fold; dispersal was significantly reduced when physician 4 wore a mask (P < or = 0.015).. Physician 4 became a "cloud adult," analogous to the "cloud babies" described by Eichenwald and coworkers who shed S. aureus into the air in association with viral URIs. Airborne dispersal of S. aureus in association with a URI may be an important mechanism of transmission of S. aureus.

Topics: Adult; Air Microbiology; Carrier State; Common Cold; Cross Infection; Drug Resistance, Microbial; Humans; Infant, Newborn; Male; Methicillin; Nose; Rhinovirus; Risk Factors; Staphylococcal Infections; Staphylococcal Skin Infections; Staphylococcus aureus

Of 166 strains of Staphylococcus aureus isolated from hospital patients and staff in Ile-Ife, Nigeria, 32% were non-typable (NT). The strains were isolated from skin lesions, eye infections, wounds and nasal flora. Isolates from skin lesions or eye and wound infections were more likely to produce protease (95% and 78% respectively) than nasal isolates (11%). Nearly all (99%) of the strains isolated were resistant to penicillin and 78% were resistant to tetracycline. Streptomycin resistance occurred in 25% of isolates; 19% were resistant to chloramphenicol and 9% to methicillin.

Topics: Anti-Bacterial Agents; Bacteriophage Typing; Carrier State; Conjunctivitis, Bacterial; Deoxyribonucleases; Drug Resistance, Microbial; Humans; Metalloendopeptidases; Nigeria; Nose; Ribonucleases; Staphylococcal Infections; Staphylococcal Skin Infections; Staphylococcus aureus; Wound Infection

In the first part of this work, we have given our own experiences of the frequency of isolation of staphylococcus aureus from nase and neck of patients with staphylodermia. Staphylococcus aureus is more often isolated from nose and neck, p less than 0.05 of patients with staphylodermia in comparison with control group. In the other part of this work we have given a review of the most frequent pathogenic and apathogenic bacteria on skin. Particularly we paid attention to the place and role of staphylococcus aureus on the human skin.

Topics: Adolescent; Adult; Child; Child, Preschool; Female; Humans; Male; Middle Aged; Nose; Pharynx; Prospective Studies; Staphylococcal Skin Infections; Staphylococcus aureus

Topics: Anti-Bacterial Agents; Drug Resistance, Microbial; Humans; Impetigo; Malaysia; Nose; Staphylococcal Skin Infections; Staphylococcus aureus

Topics: Bacteriology; Humans; Micrococcus; Nasal Cavity; Nose; Paranasal Sinuses; Staphylococcal Skin Infections