Staphylococcus aureus ‘Down Under’: contemporary epidemiology of S. aureus in Australia, New Zealand, and the South West Pacific

Williamson, Deborah A.; Coombs, Geoffrey W.; Nimmo, Graeme R.

doi:10.1111/1469-0691.12702

Cited by 48 publications

(37 citation statements)

References 62 publications

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“…The association of CC121 with SSTI is consistent with the international literature and CC121 is phenotypically usually MSSA [22]. The molecular epidemiology of MSSA infections has been studied in less detail than CA-MRSA [23], but CC121 is commonly associated with SSTIs in Australia. However, the high prevalence of CC121 in our study (30%) is greater than that reported elsewhere in the Northern Territory ‘Top End’ and metropolitan centers [9, 18], and may be a unique feature of the Central Australian region.…”

Section: Discussionsupporting

confidence: 77%

High burden of complicated skin and soft tissue infections in the Indigenous population of Central Australia due to dominant Panton Valentine leucocidin clones ST93-MRSA and CC121-MSSA

et al. 2017

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BackgroundSuperficial skin and soft tissue infections (SSTIs) are common among the Indigenous population of the desert regions of Central Australia. However, the overall burden of disease and molecular epidemiology of Staphylococcus aureus complicated SSTIs has yet to be described in this unique population.MethodsAlice Springs Hospital (ASH) admission data was interrogated to establish the population incidence of SSTIs. A prospective observational study was conducted on a subset of S. aureus complicated SSTIs (carbuncles and furuncles requiring surgical intervention) presenting during a one month period to further characterize the clinical and molecular epidemiology. High resolution melting analysis was used for clonal complex discrimination. Real-time polymerase chain reaction identifying the lukF component of the Panton Valentine leucocidin (pvl) gene determined pvl status. Clinical and outcome data was obtained from the ASH medical and Northern Territory shared electronic health records.ResultsSSTIs represented 2.1% of ASH admissions during 2014. 82.6% occurred in Indigenous patients (n = 382) with an estimated incidence of 18.9 per 1, 000 people years compared to the non-Indigenous population of 2.9 per 1000, with an incident rate ratio of 6.6 (95% confidence interval 5.1–8.5). Clinical and molecular analysis was performed on 50 isolates from 47 patients. Community-associated methicillin-resistant S. aureus (CA-MRSA) predominated (57% of isolates). The high burden of SSTIs is partly explained by the prevalence of pvl positive strains of S. aureus (90% isolates) for both CA-MRSA and methicillin-susceptible S. aureus (MSSA). ST93-MRSA and CC121-MSSA were the most prevalent clones. SSTIs due to ST93-MRSA were more likely to require further debridement (p = 0.039), however they also more frequently received inactive antimicrobial therapy (p < 0.001).ConclusionsST93-MRSA and CC121-MSSA are the dominant causes of carbuncles and furuncles in Central Australia. Both of these virulent clones harbor pvl but the impact on clinical outcomes remains uncertain. The high prevalence of CA-MRSA supports empiric vancomycin use in this population when antimicrobial therapy is indicated. Prompt surgical intervention remains the cornerstone of treatment.

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Section: Discussionsupporting

confidence: 77%

High burden of complicated skin and soft tissue infections in the Indigenous population of Central Australia due to dominant Panton Valentine leucocidin clones ST93-MRSA and CC121-MSSA

et al. 2017

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“…Community‐acquired methicillin‐resistant Staphylococcus aureus (‘CA‐MRSA’) now accounts for 25% of S. aureus infections in some parts of Australia, with risk factors including race (Aboriginal, Maori, Pacific Islander), communal living (prisons, boarding houses), i.v. drug use and poor self‐care . Dominant CA‐MRSA clones and resistance patterns can vary widely between locations, so local data and early infectious diseases specialist input are required to guide empiric therapy …”

Section: Antimicrobialsmentioning

confidence: 99%

“…drug use and poor self-care. 12,13 Dominant CA-MRSA clones and resistance patterns can vary widely between locations, so local data and early infectious diseases specialist input are required to guide empiric therapy. 14…”

Section: Antimicrobial Selectionmentioning

confidence: 99%

Review article: Sepsis in the emergency department – Part 3: Treatment

Williams

Keijzers

Macdonald

et al. 2018

Emerg Medicine Australasia

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Although comprehensive guidelines for treatment of sepsis exist, current research continues to refine and revise several aspects of management. Imperatives for rapid administration of broad-spectrum antibiotics for all patients with sepsis may not be supported by contemporary data. Many patients may be better served by a more judicious approach allowing consideration of investigation results and evidence-based guidelines. Conventional fluid therapy has been challenged with early evidence supporting balanced, restricted fluid and early vasopressor use. Albumin, vasopressin and hydrocortisone have each been shown to support blood pressure and reduce catecholamine requirements but without effect on mortality, and as such should be considered for ED patients with septic shock on a case-by-case basis. Measurement of quality care in sepsis should incorporate quality of blood cultures and guideline-appropriateness of antibiotics, as well as timeliness of therapy. Local audit is an essential and effective means to improve practice. Multicentre consolidation of data through agreed minimum sepsis data sets would provide baseline quality data, required for the design and evaluation of interventions.

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“…methicillin) (Van Hal et al, 2007). The prevalence of MRSA infections have increased dramatically over the past two decades (Williamson et al, 2014). According to Baiu & AL-Abdli (2015), due to antibiotics resistance, MRSA infections required more complicated treatment.…”

Section: Methicillin Resistant S Aureus (Mrsa) and Coagulase Negativementioning

confidence: 99%

Detection of methicillin resistant Staphylococcus areus isolated from nasal carriage of health care workers by polymerase chain reaction

Alsulami¹,

Doghaither²

2017

JEBAS

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Methicillin resistant Staphylococcus aureus (MRSA) and coagulase negative Staphylococci (MRCoNS) are major health problems worldwide. There is a growing concern about the rapid rise in resistance of nosocomial infections to antimicrobial agents. The aim of the present study was to determine nasal colonization of MRSA and MRCoNS among healthcare workers (HCWs) in King Abdulaziz University hospital. A total of 100 respondents were selected for this study and were classified into two groups: HCWs group which included 50 technicians and nurses, and the control group which included 50 university students. Nasal swabs from anterior nares were cultured on selective media for the presence of mecA gene that is common to these bacteria. Polymerase chain reaction (PCR) and specific primers were used to determine mecA and coagulase gene (coa). The identified isolates were tested by restriction fragment length polymorphism (RFLP). Results of current study revealed that among 50 HCWs, 21 (42%) were nasal carriers for MRCoNS and 12 (24%) for MRSA. The control group was negative for MRSA and MRCoNS. The results of the current study will help in making decision to prevent the spread of infections among workers in the field of health care. KEYWORDS MRSA MRCoNS healthcare workersmecA gene

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Staphylococcus aureus ‘Down Under’: contemporary epidemiology of S. aureus in Australia, New Zealand, and the South West Pacific

Cited by 48 publications

References 62 publications

High burden of complicated skin and soft tissue infections in the Indigenous population of Central Australia due to dominant Panton Valentine leucocidin clones ST93-MRSA and CC121-MSSA

High burden of complicated skin and soft tissue infections in the Indigenous population of Central Australia due to dominant Panton Valentine leucocidin clones ST93-MRSA and CC121-MSSA

Review article: Sepsis in the emergency department – Part 3: Treatment

Detection of methicillin resistant Staphylococcus areus isolated from nasal carriage of health care workers by polymerase chain reaction

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