Clinical characteristics and epidemiology of methicillin-resistant Staphylococcus aureus (MRSA) in children with cystic fibrosis from a center with a high MRSA prevalence

Harik, Nada; Com, Gulnur; Tang, Xinyu; Castro, Maria Melguizo; Stemper, Mary E.; Carroll, John L.

doi:10.1016/j.ajic.2015.10.015

Cited by 21 publications

(21 citation statements)

References 23 publications

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“…Patient-to-patient transmission between siblings with CF or acquisition of the same strain from an identical environmental source within the family situation has been demonstrated for many bacterial pathogens, including methicillin-resistant Staphylococcus aureus, Pseudomonas aeruginosa, Stenotrophomonas maltophilia, and Achromobacter xylosoxidans (35,36,37,38). Likewise, concordance in the genotypes colonizing the respiratory tract of siblings suffering from CF has also been reported for some fungal pathogens, like Candida species (39) and Pneumocystis jirovecii (40).…”

Section: Discussionmentioning

confidence: 92%

Long-Term Rasamsonia argillacea Complex Species Colonization Revealed by PCR Amplification of Repetitive DNA Sequences in Cystic Fibrosis Patients

et al. 2016

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The aim of this work was to document molecular epidemiology of Rasamsonia argillacea species complex isolates from cystic fibrosis (CF) patients. In this work, 116 isolates belonging to this species complex and collected from 26 CF patients and one patient with chronic granulomatous disease were characterized using PCR amplification assays of repetitive DNA sequences and electrophoretic separation of amplicons (rep-PCR). Data revealed a clustering consistent with molecular species identification. A single species was recovered from most patients. Rasamsonia aegroticola was the most common species, followed by R. argillacea sensu stricto and R. piperina, while R. eburnea was not identified. Of 29 genotypes, 7 were shared by distinct patients while 22 were patient specific. In each clinical sample, most isolates exhibited an identical genotype. Genotyping of isolates recovered from sequential samples from the same patient confirmed the capability of R. aegroticola and R. argillacea isolates to chronically colonize the airways. A unique genotype was recovered from two siblings during a 6-month period. In the other cases, a largely dominant genotype was detected. Present results which support the use of rep-PCR for both identification and genotyping for the R. argillacea species complex provide the first molecular evidence of chronic airway colonization by these fungi in CF patients.R asamsonia argillacea, which was first reported in clinical practice as a Penicillium species, then reclassified in the genus Geosmithia, and finally reassigned in 2013 to the new genus Rasamsonia, is now considered an emerging pathogen (1). Since its first report in humans as Penicillium emersonii (2), there has been an increasing number of cases reported in both dogs (3, 4, 5) and humans (6). Nevertheless, it is likely that the number of human infections caused by this fungus has long been underestimated because of the lack of specificity of its morphological features and to subsequent misidentifications with some Penicillium or Paecilomyces species.Only six species were previously recognized in the genus Rasamsonia described in 2012, i.e., R. argillacea, R. composticola, R. brevistipitata, R. byssochlamydoides, R. cylindrospora, and R. emersonii (7). However, multilocus sequence analysis of several R. argillacea isolates revealed a clustering which superimposed some phenotypic differences. Therefore, R. argillacea is now considered a species complex comprising four distinct species: R. argillacea sensu stricto, R. piperina, R. aegroticola, and R. eburnea (8).Infections caused by species of the R. argillacea complex have been reported in various clinical contexts in human. Chronic granulomatous disease (CGD) (9, 10, 11) and cystic fibrosis (CF) (12,13,14,15,16,17) are the major underlying clinical conditions. Rasamsonia infections may also occur in bone marrow transplant recipients (18, 19) but also may occur in the absence of any predisposing factors, as evidenced by the pulmonary and aortic graft infection reported by Doyon et al. (...

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Section: Discussionmentioning

confidence: 92%

Long-Term Rasamsonia argillacea Complex Species Colonization Revealed by PCR Amplification of Repetitive DNA Sequences in Cystic Fibrosis Patients

et al. 2016

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“…This finding corroborates prior reports of exposure to healthcare settings as a risk factor for MRSA acquisition. 4,14,16 For patients receiving care in CF centers with high MRSA rates, 15 the combination of socio-environmental and healthcare exposures may result in a risk proliferation that exacerbates inequities. Importantly, area deprivation was not associated with number of clinic visits or hospitalizations, confirming previous reports that disparities in pediatric CF outcomes are not driven by differential healthcare access.…”

Section: Discussionmentioning

confidence: 99%

“…1 In one CF center with high MRSA prevalence, MRSA rates have increased from 1% to 49% between 1997 and 2009. 4 Persistent infection with MRSA is a known contributor to CF morbidity and mortality. CF patients with persistent MRSA infection have lower lung function, [5][6][7] accelerated lung function decline 8,9 and impaired lung function recovery after exacerbation 10 and require increased maintenance and antibiotic therapies.…”

mentioning

confidence: 99%

“…6,11,12 MRSA-infected CF patients have a 27% higher risk of death and a 6.2-year shorter life than non-infected counterparts. 13 Previously reported clinical risk factors for MRSA infection include co-infection with P. aeruginosa, 14,15 cystic fibrosis-related diabetes (CFRD), 15 exposure to a healthcare setting 4,[14][15][16] and receiving care at a CF Center with high prevalence of MRSA. 15 There is also evidence for environmental risks, such as higher ambient temperature, 17 air pollution 18 and tobacco smoke exposure.…”

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confidence: 99%

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Area Deprivation as a Risk Factor for Methicillin-resistant Staphylococcus aureus Infection in Pediatric Cystic Fibrosis

Oates

Harris

Rowe

et al. 2019

Pediatric Infectious Disease Journal

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Background: In US cystic fibrosis (CF) patients, methicillin-resistant Staphylococcus aureus (MRSA) rates have tripled in the past 2 decades. Known clinical risk factors include exposure to a healthcare setting, Pseudomonas aeruginosa and CF-related diabetes. Area-level socioenvironmental exposures have not been evaluated. We explored the association of area-level deprivation with MRSA prevalence in a pediatric CF Center in the Southeastern United States. Methods: Patients' residential addresses were geocoded and linked to a composite Area Deprivation Index and Rural-Urban Commuting Area scores. The association of MRSA with Area Deprivation Index and Rural-Urban Commuting Area scores was evaluated using logistic regression with robust standard errors adjusted for sociodemographic covariates (age, sex, race, mother's and father's education and household income), clinical risk factors (P. aeruginosa, CFrelated diabetes, hospitalizations and number of clinic visits) and clustering. Results: The study included all pediatric patients (N = 231; mean age 12) at a single CF Center. MRSA was present in 44% of subjects. Higher area-level deprivation was correlated with rural residence, lack of parental college education and lower household income (P < 0.001 for each). In a multiple regression model fully adjusted for patient-level sociodemographic covariates, clinical risk factors and clustering, neighborhood deprivation was associated with more than 2-fold increase in the odds of having MRSA [OR 2.26 (1.14-4.45), P < 0.05]. Conclusions: Neighborhood deprivation is a risk factor for MRSA in pediatric CF, doubling the odds of infection. Community-level socioeconomic risk factors should be considered when developing prevention strategies and treatment plans for MRSA infection in pediatric patients with CF.

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“…MRSA infection contributes to pulmonary morbidity in CF. While rates are highly variable at US CF Centers, the CF Center at the University of Arkansas has the highest rate of MRSA infection among US Centers . From 1997‐2009, the rate of MRSA increased from 1% to 49% in the population, and 26% of children had persistent MRSA.…”

Section: Infections and Pulmonary Complicationsmentioning

confidence: 99%

Cystic fibrosis year in review 2016

Savant

McColley

2017

Pediatr Pulmonol

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Clinical characteristics and epidemiology of methicillin-resistant Staphylococcus aureus (MRSA) in children with cystic fibrosis from a center with a high MRSA prevalence

Cited by 21 publications

References 23 publications

Long-Term Rasamsonia argillacea Complex Species Colonization Revealed by PCR Amplification of Repetitive DNA Sequences in Cystic Fibrosis Patients

Long-Term Rasamsonia argillacea Complex Species Colonization Revealed by PCR Amplification of Repetitive DNA Sequences in Cystic Fibrosis Patients

Area Deprivation as a Risk Factor for Methicillin-resistant Staphylococcus aureus Infection in Pediatric Cystic Fibrosis

Cystic fibrosis year in review 2016

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