Objective:This study was conducted to update the prevalence of methicillin-resistant Staphylococcus aureus(MRSA) isolates among human clinical S.aureus isolates recovered from Northern Palestine,to evaluate the possib...Objective:This study was conducted to update the prevalence of methicillin-resistant Staphylococcus aureus(MRSA) isolates among human clinical S.aureus isolates recovered from Northern Palestine,to evaluate the possible presence of vancomycin-Resistant S.aureus(VRSA) and vancomycin- intermediate resistant S.aureus strains(VISA) and to determine the antimicrobial susceptibilities of these clinical isolates.Methods:The in vitro activities of 11 antibiotics against 204 non-duplicate S.aureus isolates from clinical samples in North of Palestine were determined by the diskdiffusion method.These samples were isolated between June 2006 and December 2007.The minimum inhibitory concentration (MIC) of vancomycin for 115 methicillin resistant Staphylococcus aureus(MRSA) strains was carried out using the agar dilution method.Results:One hundred and fifteen(56.4%) of these isolates were MRSA and according to their antibiotic profile these are multidrug resistant(resistant to three or more non-p-lactam antibiotics). Ninety nine(43.6%) isolates were methicillin sensitive S.aureus(MSSA),forty four of MSSA isolates(44.4%) were multidrug resistant,while forty five(45.6%) were non multidrug resistant.Our results showed that the most common resistance(95.6%) was to penicillin.Two strains of MRSA have shown to be vancomycin- intermediate resistant,had MIC of 4μg/rnL and 8μg/mL and these vancomycin- intermediate resistant S.aureus strains(VISA) are resistant to all antibiotics tested.Conclusion:According to our information this is the first study report about VISA in Palestine.展开更多
The first described vancomycin resistant enterococci (VRE) was about twenty years ago. Recently VRE have been reported by many clinics. However endocarditis due to VRE is still a rare entity and there are only a few c...The first described vancomycin resistant enterococci (VRE) was about twenty years ago. Recently VRE have been reported by many clinics. However endocarditis due to VRE is still a rare entity and there are only a few cases reported in the literature. We are reporting a 59-year-old male patient with chronic renal failure who was on hemodialysis. He presented with a sudden onset of fever, tachycardia and respiratory distress. The performed echocardiography revealed vegetations on the mitral and aortic valves. As he was diagnosed to have infective endocarditis the patient was put on ampicillin and gentamicin therapy. He underwent an emergent mitral and aortic valve surgery due to ensued heart failure. While he was still on ampicillin and gentamicin therapy, E. gallinarum, which was resistant to vancomycin (MIC = 8 mg/L), was isolated from the surgical valve specimens and hence his antibiotic regime was switched to teicoplanin (MIC < 0.5 mg/L). 28 days after teicoplanin therapy the patient was discharged with free of symptoms and any complication. This patient is presented as an example for an endocarditis with an unusual type of enterococci.展开更多
Background The emergence of heteroresistant vancomycin-intermediate Staphylococcus aureus （hVISA） is increasingly challenging the methods for detection in diagnostic microbiology laboratories. However, the report of...Background The emergence of heteroresistant vancomycin-intermediate Staphylococcus aureus （hVISA） is increasingly challenging the methods for detection in diagnostic microbiology laboratories. However, the report of hVISA is rare in China. This study summarizes the prevalence and clinical features associated with hVISA infections at our institution and the local impact they have on clinical outcome. Methods A total of 122 methicillin-resistant Staphylococcus aureus （MRSA） isolates which were of the causative pathogens were collected. One hundred and two patients for whom we had full information of MRSA pneumonia were included. Isolates of MRSA were collected using PCR to detect the mecA gene. Both Etest and macro Etest were performed to screen for hVISA. The Staphylococcal chromosome cassette mec （SCCmec） types were determined by multiplex PCR strategy. Logistic regression analysis was used to determine the risk factors. Results Among the 122 MRSA isolates collected, 25 （20.5%） strains were identified as hVISA. There were 119 （97.5%） SCCmec III isolates, two （1.6%） SCCmec II isolates, and one （0.8%） SCCmec V isolate. The 30-day mortality of MRSA-hospital acquired pneumonia （HAP） was 37.3%, and 62.5% for hVISA-HAP. Vancomycin treatment was the independent risk factor of hVISA. Factors independently associated with 30-day mortality in all patients were acute physiology and Chronic Health Evaluation （APACHE） II score 〉20, multiple lobe lesions, and creatinine clearance rate （CCR） 〈15 ml/min. Conclusions The prevalence of hVISA is 20.5% at our institution, hVISA-HAP patients had a poor clinical outcome. Vancomycin treatment was the independent predictors for hVISA infection. Factors independently associated with 30-day mortality in all patients were APACHE II score 〉20, multiple lobe lesions and CCR 〈15 ml/min.展开更多
Background Proactive infection control management is crucial in preventing the introduction of multiple drug resistant organisms in the healthcare setting. In Hong Kong, where vancomycin-resistant enterococci （VRE） ...Background Proactive infection control management is crucial in preventing the introduction of multiple drug resistant organisms in the healthcare setting. In Hong Kong, where vancomycin-resistant enterococci （VRE） endemicity is not yet established, contact tracing and screening, together with other infection control measures are essential in limiting intra- and inter-hospital transmission. The objective of this study was to illustrate the control measures used to eradicate a VRE outbreak in a hospital network in Hong Kong. Methods We described an outbreak of VRE in a healthcare region in Hong Kong, involving a University affiliated hospital and a convalescent hospital of 1600 and 550 beds respectively. Computer-assisted analysis was utilized to facilitate contact tracing, followed by VRE screening using chromogenic agar. Multi-locus sequence typing （MLST） was performed to assess the clonality of the VRE strains isolated. A case-control study was conducted to identify the risk factors for nosocomial acquisition of VRE. Results Between November 26 and December 17, 2011, 11 patients （1 exogenous case and 10 secondary cases） in two hospitals with VRE colonization were detected during our outbreak investigation and screening for 361 contact patients, resulting in a clinical attack rate of 2.8% （10/361）. There were 8 males and 3 females with a median age of 78 years （range, 40-87 years）. MLST confirmed sequence type ST414 in all isolates. Case-control analysis demonstrated that VRE positive cases had a significantly longer cumulative length of stay （P 〈0.001）, a higher proportion with chronic cerebral and cardiopulmonary conditions （P=0.001）, underlying malignancies （P 〈0.001）, and presence of urinary catheter （P 〈0.001）, wound or ulcer （P 〈0.001）, and a greater proportion of these patients were receiving β-lactam/ β-1actamase inhibitors （P=0.009）, carbapenem group （P 〈0.001）, fluoroquinolones （P=0.003）, or vancomycin （P=0.001） when compared with the controls. Conclusion Extensive contact tracing and screening with a ＂search-and-confine＂ strategy was a successful tool for outbreak control in our healthcare reqion.展开更多
Background： Vancomycin-resistant enterococci （VRE） are a major and emerging hospital-acquired pathogen associated with high mortality, particularly among the critically ill and Intensive Care Units （ICUs） patient...Background： Vancomycin-resistant enterococci （VRE） are a major and emerging hospital-acquired pathogen associated with high mortality, particularly among the critically ill and Intensive Care Units （ICUs） patients. This study aimed to determine the prevalence and demographic and clinical characteristics of VRE among patients admitted to a university hospital in Riyadh, Saudi Arabia. Methods： A study was conducted during the period from September 2014 to November 2015 at King Khalid University Hospital, a tertiary care hospital in Riyadh, Saudi Arabia, including in-patients with VRE infection. Data were collected using laboratory results and the medical records of admitted patients and were analyzed using SPSS version 19.0 statistical software. Results： In a one-year period, 231 enterococci were isolated from blood, urine, exudates, sputum, stool, and body fluid. There were 191 （82.7%） vancomycin-sensitive enterococci （VSE） and 40 （I 7.3%） isolates were VRE. The Enterococcus species included E.faecalis 168 （72.7%）, E.faecium, 53 （22.8%） E. gallinarum 5 （2.2%）, and E. avium 5 （2.2%）. VRE were more significant from blood specimens （P 〈 0.000 I） while VSE were significantly more predominant from urine specimens （P 〈 0.0001）. VRE were more commonly isolated from patients in ICUs and oncology unit （P = 0.0151 and P 〈 0.001, respectively） while VSE were more predominant in the medical and surgical areas （P = 0.0178 and P = 0.0178, respectively）. Conclusions： This study highlights the high prevalence of VRE in the hospital and the association of enterococcal infections with high-risk areas and oncology units, which warrant more studies looking for better management of these infections.展开更多
Background The incidence of vancomycin-resistant enterococci （VRE） appeared to be increasing in China, but very few nosocomial outbreaks have been reported. Our hospital had experienced an outbreak of VRE since Marc...Background The incidence of vancomycin-resistant enterococci （VRE） appeared to be increasing in China, but very few nosocomial outbreaks have been reported. Our hospital had experienced an outbreak of VRE since March 2008 to March 2009. The objective of this study was to analyze the molecular features of the isolates and the control measures used to eradicate a VRE outbreak in a tertiary institution in China.Methods We characterized VRE isolates from 21 infected and 11 colonized inpatients from a single hospital by pulsed field gel electrophoresis （PFGE）, multilocus sequence typing （MLST）, the analysis of Tn 1546-like elements and virulence genes detection. Infection control measures, including more environmental disinfection, screening for VRE colonization,contact precautions, education and strict antibiotic restriction, were implemented to control the outbreak.Results During the outbreak, a total of 32 VRE strains were obtained. There were 21 strains found in Emergency Intensive Care Unit （EICU）, 9 isolates from Geriatric Ward, and two from other units. All the isolates harbored the vanA gene, however,four of them exhibited the VanB phenotype. Meanwhile, MLST analysis revealed that all isolates belonged to clonal complex （CC） 17. With the infection-control measures, the epidemic was constrained in two units （EICU and Geriatric Ward）. After March 2009, no further case infected with VRE was detected in the following one-year period.Conclusion The outbreak was controlled by continuous implementation of the infection control programme, and more rigorous infection control policy is needed.展开更多
文摘Objective:This study was conducted to update the prevalence of methicillin-resistant Staphylococcus aureus(MRSA) isolates among human clinical S.aureus isolates recovered from Northern Palestine,to evaluate the possible presence of vancomycin-Resistant S.aureus(VRSA) and vancomycin- intermediate resistant S.aureus strains(VISA) and to determine the antimicrobial susceptibilities of these clinical isolates.Methods:The in vitro activities of 11 antibiotics against 204 non-duplicate S.aureus isolates from clinical samples in North of Palestine were determined by the diskdiffusion method.These samples were isolated between June 2006 and December 2007.The minimum inhibitory concentration (MIC) of vancomycin for 115 methicillin resistant Staphylococcus aureus(MRSA) strains was carried out using the agar dilution method.Results:One hundred and fifteen(56.4%) of these isolates were MRSA and according to their antibiotic profile these are multidrug resistant(resistant to three or more non-p-lactam antibiotics). Ninety nine(43.6%) isolates were methicillin sensitive S.aureus(MSSA),forty four of MSSA isolates(44.4%) were multidrug resistant,while forty five(45.6%) were non multidrug resistant.Our results showed that the most common resistance(95.6%) was to penicillin.Two strains of MRSA have shown to be vancomycin- intermediate resistant,had MIC of 4μg/rnL and 8μg/mL and these vancomycin- intermediate resistant S.aureus strains(VISA) are resistant to all antibiotics tested.Conclusion:According to our information this is the first study report about VISA in Palestine.
文摘The first described vancomycin resistant enterococci (VRE) was about twenty years ago. Recently VRE have been reported by many clinics. However endocarditis due to VRE is still a rare entity and there are only a few cases reported in the literature. We are reporting a 59-year-old male patient with chronic renal failure who was on hemodialysis. He presented with a sudden onset of fever, tachycardia and respiratory distress. The performed echocardiography revealed vegetations on the mitral and aortic valves. As he was diagnosed to have infective endocarditis the patient was put on ampicillin and gentamicin therapy. He underwent an emergent mitral and aortic valve surgery due to ensued heart failure. While he was still on ampicillin and gentamicin therapy, E. gallinarum, which was resistant to vancomycin (MIC = 8 mg/L), was isolated from the surgical valve specimens and hence his antibiotic regime was switched to teicoplanin (MIC < 0.5 mg/L). 28 days after teicoplanin therapy the patient was discharged with free of symptoms and any complication. This patient is presented as an example for an endocarditis with an unusual type of enterococci.
基金This research was supported by a grant from the National Natural Science Foundation of China
文摘Background The emergence of heteroresistant vancomycin-intermediate Staphylococcus aureus （hVISA） is increasingly challenging the methods for detection in diagnostic microbiology laboratories. However, the report of hVISA is rare in China. This study summarizes the prevalence and clinical features associated with hVISA infections at our institution and the local impact they have on clinical outcome. Methods A total of 122 methicillin-resistant Staphylococcus aureus （MRSA） isolates which were of the causative pathogens were collected. One hundred and two patients for whom we had full information of MRSA pneumonia were included. Isolates of MRSA were collected using PCR to detect the mecA gene. Both Etest and macro Etest were performed to screen for hVISA. The Staphylococcal chromosome cassette mec （SCCmec） types were determined by multiplex PCR strategy. Logistic regression analysis was used to determine the risk factors. Results Among the 122 MRSA isolates collected, 25 （20.5%） strains were identified as hVISA. There were 119 （97.5%） SCCmec III isolates, two （1.6%） SCCmec II isolates, and one （0.8%） SCCmec V isolate. The 30-day mortality of MRSA-hospital acquired pneumonia （HAP） was 37.3%, and 62.5% for hVISA-HAP. Vancomycin treatment was the independent risk factor of hVISA. Factors independently associated with 30-day mortality in all patients were acute physiology and Chronic Health Evaluation （APACHE） II score 〉20, multiple lobe lesions, and creatinine clearance rate （CCR） 〈15 ml/min. Conclusions The prevalence of hVISA is 20.5% at our institution, hVISA-HAP patients had a poor clinical outcome. Vancomycin treatment was the independent predictors for hVISA infection. Factors independently associated with 30-day mortality in all patients were APACHE II score 〉20, multiple lobe lesions and CCR 〈15 ml/min.
文摘Background Proactive infection control management is crucial in preventing the introduction of multiple drug resistant organisms in the healthcare setting. In Hong Kong, where vancomycin-resistant enterococci （VRE） endemicity is not yet established, contact tracing and screening, together with other infection control measures are essential in limiting intra- and inter-hospital transmission. The objective of this study was to illustrate the control measures used to eradicate a VRE outbreak in a hospital network in Hong Kong. Methods We described an outbreak of VRE in a healthcare region in Hong Kong, involving a University affiliated hospital and a convalescent hospital of 1600 and 550 beds respectively. Computer-assisted analysis was utilized to facilitate contact tracing, followed by VRE screening using chromogenic agar. Multi-locus sequence typing （MLST） was performed to assess the clonality of the VRE strains isolated. A case-control study was conducted to identify the risk factors for nosocomial acquisition of VRE. Results Between November 26 and December 17, 2011, 11 patients （1 exogenous case and 10 secondary cases） in two hospitals with VRE colonization were detected during our outbreak investigation and screening for 361 contact patients, resulting in a clinical attack rate of 2.8% （10/361）. There were 8 males and 3 females with a median age of 78 years （range, 40-87 years）. MLST confirmed sequence type ST414 in all isolates. Case-control analysis demonstrated that VRE positive cases had a significantly longer cumulative length of stay （P 〈0.001）, a higher proportion with chronic cerebral and cardiopulmonary conditions （P=0.001）, underlying malignancies （P 〈0.001）, and presence of urinary catheter （P 〈0.001）, wound or ulcer （P 〈0.001）, and a greater proportion of these patients were receiving β-lactam/ β-1actamase inhibitors （P=0.009）, carbapenem group （P 〈0.001）, fluoroquinolones （P=0.003）, or vancomycin （P=0.001） when compared with the controls. Conclusion Extensive contact tracing and screening with a ＂search-and-confine＂ strategy was a successful tool for outbreak control in our healthcare reqion.
文摘Background： Vancomycin-resistant enterococci （VRE） are a major and emerging hospital-acquired pathogen associated with high mortality, particularly among the critically ill and Intensive Care Units （ICUs） patients. This study aimed to determine the prevalence and demographic and clinical characteristics of VRE among patients admitted to a university hospital in Riyadh, Saudi Arabia. Methods： A study was conducted during the period from September 2014 to November 2015 at King Khalid University Hospital, a tertiary care hospital in Riyadh, Saudi Arabia, including in-patients with VRE infection. Data were collected using laboratory results and the medical records of admitted patients and were analyzed using SPSS version 19.0 statistical software. Results： In a one-year period, 231 enterococci were isolated from blood, urine, exudates, sputum, stool, and body fluid. There were 191 （82.7%） vancomycin-sensitive enterococci （VSE） and 40 （I 7.3%） isolates were VRE. The Enterococcus species included E.faecalis 168 （72.7%）, E.faecium, 53 （22.8%） E. gallinarum 5 （2.2%）, and E. avium 5 （2.2%）. VRE were more significant from blood specimens （P 〈 0.000 I） while VSE were significantly more predominant from urine specimens （P 〈 0.0001）. VRE were more commonly isolated from patients in ICUs and oncology unit （P = 0.0151 and P 〈 0.001, respectively） while VSE were more predominant in the medical and surgical areas （P = 0.0178 and P = 0.0178, respectively）. Conclusions： This study highlights the high prevalence of VRE in the hospital and the association of enterococcal infections with high-risk areas and oncology units, which warrant more studies looking for better management of these infections.
文摘Background The incidence of vancomycin-resistant enterococci （VRE） appeared to be increasing in China, but very few nosocomial outbreaks have been reported. Our hospital had experienced an outbreak of VRE since March 2008 to March 2009. The objective of this study was to analyze the molecular features of the isolates and the control measures used to eradicate a VRE outbreak in a tertiary institution in China.Methods We characterized VRE isolates from 21 infected and 11 colonized inpatients from a single hospital by pulsed field gel electrophoresis （PFGE）, multilocus sequence typing （MLST）, the analysis of Tn 1546-like elements and virulence genes detection. Infection control measures, including more environmental disinfection, screening for VRE colonization,contact precautions, education and strict antibiotic restriction, were implemented to control the outbreak.Results During the outbreak, a total of 32 VRE strains were obtained. There were 21 strains found in Emergency Intensive Care Unit （EICU）, 9 isolates from Geriatric Ward, and two from other units. All the isolates harbored the vanA gene, however,four of them exhibited the VanB phenotype. Meanwhile, MLST analysis revealed that all isolates belonged to clonal complex （CC） 17. With the infection-control measures, the epidemic was constrained in two units （EICU and Geriatric Ward）. After March 2009, no further case infected with VRE was detected in the following one-year period.Conclusion The outbreak was controlled by continuous implementation of the infection control programme, and more rigorous infection control policy is needed.
