Molecular analysis of an increase in trimethoprim/sulfamethoxazole-resistant MRSA reveals multiple introductions into a tertiary care hospital, Germany 2012–19

Nurjadi, Dennis; Klein, Sabrina; Hannesen, Julius; Heeg, Klaus; Boutin, Sébastien; Zanger, Philipp

doi:10.1093/jac/dkab341

Cited by 8 publications

(5 citation statements)

References 34 publications

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“…Resistance rates for gentamicin (15.2%) and trimethoprim-sulfamethoxazol (8.8%) observed in our study were comparable to those of two studies in Heidelberg, Southwestern Germany [ 23 , 34 ], whereas 17.6% of our isolates displayed phenotypic resistance against tetracycline, compared to 39.1% reported there.…”

Section: Discussionsupporting

confidence: 86%

Characterization of PVL-Positive MRSA Isolates in Northern Bavaria, Germany over an Eight-Year Period

et al. 2022

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Purpose: Community-acquired methicillin-resistant Staphylococcus aureus strains (CA-MRSA) are spread worldwide and often cause recurring and persistent infections in humans. CA-MRSA strains frequently carry Panton–Valentine leukocidin (PVL) as a distinctive virulence factor. This study investigates the molecular epidemiology, antibiotic resistance and clinical characteristics of PVL-positive MRSA strains in Northern Bavaria, Germany, isolated over an eight-year period. Methods: Strains were identified by MALDI-TOF MS and antibiotic susceptibility was tested by automated microdilution (VITEK 2) or disk diffusion. PVL-encoding genes and mecA were detected by PCR. MRSA clonal complexes (CC) and lineages were assigned by genotyping via DNA microarray and spa-typing. Results: In total, 131 PVL-positive MRSA were collected from five hospital sites between 2009 and 2016. Predominant lineages were CC8-MRSA-[IV+ACME], USA300 (27/131; 20.6%); CC30-MRSA-IV, Southwest Pacific Clone (26/131; 19.8%) and CC80-MRSA-IV (25/131; 19.1%). Other CCs were detected less frequently. Resistance against erythromycin and clindamycin was prevalent, whereas all strains were sensitive towards vancomycin and linezolid. In total, 100 cases (76.3%) were causally linked to an infection. The majority (102/131; 77.9%) of isolates were detected in skin swabs or swabs from surgical sites. Conclusions: During the sample period we found an increase in the PVL-positive MRSA lineages CC30 and CC1. Compared to less-abundant lineages CC1 or CC22, the predominant lineages CC8, CC30 and CC80 harbored a broader resistance spectrum. Furthermore, these lineages are probably associated with a travel and migration background. In the spatio-temporal setting we investigated, these were arguably drivers of diversification and change in the landscape of PVL-positive MRSA.

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Section: Discussionsupporting

confidence: 86%

Characterization of PVL-Positive MRSA Isolates in Northern Bavaria, Germany over an Eight-Year Period

et al. 2022

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“… 184 , 185 However, an increase in resistance to TMP-SMX in MRSA has been reported in recent years. 186 , 187 Additionally, the possible induction of SCV formation must be taken into consideration. Furthermore, newer antibiotics that did not appear in our search at the time of the study should be evaluated for their potential intracellular effectiveness.…”

Section: Discussionmentioning

confidence: 99%

Can intracellular Staphylococcus aureus in osteomyelitis be treated using current antibiotics? A systematic review and narrative synthesis

et al. 2022

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Approximately 40% of treatments of chronic and recurrent osteomyelitis fail in part due to bacterial persistence. Staphylococcus aureus, the predominant pathogen in human osteomyelitis, is known to persist by phenotypic adaptation as small-colony variants (SCVs) and by formation of intracellular reservoirs, including those in major bone cell types, reducing susceptibility to antibiotics. Intracellular infections with S. aureus are difficult to treat; however, there are no evidence-based clinical guidelines addressing these infections in osteomyelitis. We conducted a systematic review of the literature to determine the demonstrated efficacy of all antibiotics against intracellular S. aureus relevant to osteomyelitis, including protein biosynthesis inhibitors (lincosamides, streptogramins, macrolides, oxazolidines, tetracyclines, fusidic acid, and aminoglycosides), enzyme inhibitors (fluoroquinolones and ansamycines), and cell wall inhibitors (beta-lactam inhibitors, glycopeptides, fosfomycin, and lipopeptides). The PubMed and Embase databases were screened for articles related to intracellular S. aureus infections that compared the effectiveness of multiple antibiotics or a single antibiotic together with another treatment, which resulted in 34 full-text articles fitting the inclusion criteria. The combined findings of these studies were largely inconclusive, most likely due to the plethora of methodologies utilized. Therefore, the reported findings in the context of the models employed and possible solutions for improved understanding are explored here. While rifampicin, oritavancin, linezolid, moxifloxacin and oxacillin were identified as the most effective potential intracellular treatments, the scientific evidence for these is still relatively weak. We advocate for more standardized research on determining the intracellular effectiveness of antibiotics in S. aureus osteomyelitis to improve treatments and patient outcomes.

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“… 42 In addition, our data showed an overall increase in trimethoprim-sulfamethoxazole resistance in MRSA over years, similar to published studies from United States and Germany. 43 , 44 Trimethoprim-sulfamethoxazole is considered as alternative agents for the treatment of certain MRSA infection and is sometimes used in salvage therapy. 45 …”

Section: Discussionmentioning

confidence: 99%

Predictive Role of Targeted, Active Surveillance Cultures for Detection of Methicillin-Resistant Staphylococcus aureus

Musawi

Alkhaleefa

Alnassri

et al. 2021

IDR

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Molecular analysis of an increase in trimethoprim/sulfamethoxazole-resistant MRSA reveals multiple introductions into a tertiary care hospital, Germany 2012–19

Cited by 8 publications

References 34 publications

Characterization of PVL-Positive MRSA Isolates in Northern Bavaria, Germany over an Eight-Year Period

Characterization of PVL-Positive MRSA Isolates in Northern Bavaria, Germany over an Eight-Year Period

Can intracellular Staphylococcus aureus in osteomyelitis be treated using current antibiotics? A systematic review and narrative synthesis

Predictive Role of Targeted, Active Surveillance Cultures for Detection of Methicillin-Resistant Staphylococcus aureus

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