A total of 156 methicillin-resistant Staphylococcus aureus (MRSA) isolates from patients hospitalized in southern Iran were tested for staphylococcal cassette chromosome mec (SCCmec) types and antibacterial susceptibility patterns between May 2008 and May 2009. Type III SCCmec was the most prevalent (116, 74.3%), followed by mec types A (147 bp only; 11, 7.1%), IVa (8, 5.1%), IVc (7, 4.5%), IVd and V (4, 2.6%), and II (1, 0.6%). Class A mec and type III ccr and mec complexes were also predominant. All isolates were found to be sensitive to vancomycin, teicoplanin, linezolid, quinupristin-dalfopristin, mupirocin, and fusidic acid. However, reduced sensitivity of these MRSA isolates to other antibiotics, including rifampin, co-trimoxazole, clindamycin, cephalexin, tetracycline, ciprofloxacin, erythromycin, and gentamicin, was also observed. The predomination of type III SCCmec could be due to the antibiotic pressure which facilitated its clonal selection and dissemination. The present findings are indicative of the existence of community-acquired types (IV, V) in the hospitals studied, therefore comprehensive and periodic control measures and rational prescription of appropriate antibiotics are highly recommended to reduce antibiotic resistance.
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Methicillin-resistant Staphylococcus aureus (MRSA) infections were uncommon in children in Canada until the 1990s. Using a standardized case report form, treating physicians reported children hospitalized due to MRSA infections in Canadian hospitals through the Canadian Pediatric Surveillance Program in a 24-month period (2008 to 2010). Of 155 cases reported, 70% were ≤4 years of age and approximately one-third had an underlying medical condition. The most common clinical infections involved skin and soft tissue (69%), the lower respiratory tract (12%), and bone and joint (10%). Almost one-third had had contact with the health care environment in the previous year and 18% had a known household member with MRSA. Initial therapy with a beta-lactam alone occurred in 65%, while 22% included vancomycin. No child in this cohort died but 14% required admission to the intensive care unit. Of 143 reports of individual isolates, 93% were reported susceptible to trimethoprim-sulfamethoxazole, 63% to clindamycin and 50% to mupirocin. The present study involved only children hospitalized with MRSA infections. It may not be representative of the children treated as outpatients nor children in selected areas of Canada where MRSA infections may be more endemic. Further targeted surveillance to identify risks and treatment practices in these populations may be important.
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Retapamulin is a novel pleuromutilin antibacterial developed for topical use.
The overall purpose of this study was to examine the lactobacilli and bifidobacteria microbiota in the human ileum at a very early stage of life. Ileostomy effluents from two infants, taken at different time points, were plated on Lactobacillus selective agar and cys-MRS containing mupirocin to select for bifidobacteria. In one case, a stool sample following ileostomy reversal was subsequently analyzed microbiologically. Pulse-field gel electrophoresis and 16S rRNA sequencing was used to investigate the cultivable population of bifidobacteria and lactobacilli and denaturing gradient gel electrophoresis (DGGE) to examine the non-cultivable population. The probiotic strain, Lactobacillus paracasei NFBC 338, was recovered at both time points from one of the infants and dominated in the small intestine for a period of over 3 weeks. Moreover, the probiotic strain, B. animalis subsp. lactis Bb12, was obtained from the other infant. This study shows the presence of two known probiotic strains in the upper intestinal tract at an early stage of human life and thus provides some evidence for their ability to colonize the infant small intestine.
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Mupirocin is a unique antibiotic that is produced by Pseudomonas fluorescens, and is available for elimination of nasal carriage of methicillin-resistant Staphylococcus aureus (MRSA). However, there have been many reports that high level mupirocin resistant S. aureus were discovered in Europe, South or North American countries. In Japan, mupirocin has been only available for nasal ointment of MRSA eradication since 1996. After introduction of mupirocin, we have screened mupirocin resistance routinely in our hospital. On January 1998, we had high level mupirocin-resistant MRSA isolated from a nose of a neonate with severe nephrotic syndrome. The mupA was detected by PCR and the mupirocin-resistance could transfer to S. aureus RN2677 by filter-mating with co-transfer of gentamicin, tobramycin, kanamycin and erythromycin. This strain was eradicated after prophylactic use of vancomycin for her nephrectomy. To our knowledge, this is the first isolate of high level mupirocin-resistant MRSA in Japan.
The absence of mupA on any of the plasmids and its detection only in the chromosomal DNA of the parents and in their derivatives cured of the 26 kb plasmid strongly supports a chromosomal location for mupA in these isolates.
This study confirmed that lesional skin of patients with eczema and AD was more frequently colonized with S. aureus than was nonlesional skin. The more severe the eczema, the higher the colonization rate of S. aureus, and S. aureus was also more often present in lesional and nonlesional skin in patients with AD than in those with eczema. Staphylococcus aureus infection is related to the pathogenesis of eczema and AD. An antibiotic-corticosteroid combination and corticosteroid alone both gave good therapeutic effect in eczema and in AD, and both reduced colonization by S. aureus. Early combined topical therapy is beneficial to patients with moderate to severe eczema and AD, and it is unnecessary to use antibiotics at later stages of disease or in mild eczema or AD.
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We routinely phage-type Staphylococcus aureus isolates from high-risk inpatients each week. This surveillance approach previously identified a five-year outbreak of a methicillin-susceptible S. aureus strain (MSSA, PT 53,85), which affected 202 babies on a regional neonatal unit. We previously reported this outbreak and the multiple staged infection control measures that were required to end it. These included strict emphasis on hand hygiene, environmental and staff surveillance sampling, application of topical triclosan solution and hexachlorophane powder, aseptic handling of a skin protectant material, and use of topical mupirocin for staff nasal carriers of the endemic MSSA strain and for babies colonized or infected with S. aureus. In summer 2000 topical hexachlorophane powder became unavailable and we therefore substituted topical 1% chlorhexidine powder as part of routine umbilical decontamination. We have continued prospective S. aureus surveillance for the past five years to monitor the effect of this practice change. We observed a continued decline in the numbers of monthly MSSA isolates from neonatal unit babies. Since the substitution of chlorhexidine for hexachlorophane, the median monthly number of MRSA isolates has been 0.5 (range 0-4). Only sporadic S. aureus PT 53,85 isolates were recovered. Control of S. aureus in our regional neonatal unit, in particular an endemic MSSA strain, was maintained when topical umbilical hexachlorophane powder was substituted with 1% chlorhexidine powder.
In San Carlos University Hospital a total of 53 health care workers with nasal carriage of methicillin-resistant Staphylococcus aureus were found. That figure represents a 3.4% of all health care workers studied and also a 15.4% of methicillin-resistance among all S. aureus isolated. Among health care workers from related hospitals, only one nasal carrier was found. Forty-seven of all 53 methicillin-resistant Staphylococcus aureus isolated from San Carlos University Hospital health care workers and the strain isolated from the related hospitals health care worker were similar to the epidemic strain responsible for the outbreak. Mupirocin, as nasal ointment, was useful in eliminating nasal colonization in all cases.
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The capacity of common antiseptics such as silver nitrate, polihexanide, octenidine, chlorhexidine and polyvinylpyrrolidone (PVP)-iodine to induce adaptation in a Staphylococcus aureus strain was analyzed in vitro using microplate laser nephelometry. S. aureus was repeatedly incubated with the respective half maximal inhibitory concentration (IC(50)) over a time period of 100 days. The influence of the continued treatment was determined by in situ monitoring of changes in the dose-response curves and calculation of the current IC(50) values for the substances tested.