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1.
Med Microbiol Immunol ; 209(1): 51-57, 2020 Feb.
Article in English | MEDLINE | ID: mdl-31624909

ABSTRACT

Novel strategies are needed for combating Staphylococcus aureus biofilm in vascular graft infections. We investigated the in vitro activity of bacteriophage endolysin HY-133, daptomycin and rifampin against S. aureus attached to vascular graft surface. Daptomycin showed rapid bactericidal effect on surface-associated S. aureus, while the activity of HY-133 on graft surface-adherent cells was moderate and rifampin did not achieve bactericidal effect. Even in the highest concentrations, all antimicrobials used failed in a complete eradication of the surface-adherent bacteria.


Subject(s)
Bacteriophages/enzymology , Endopeptidases/pharmacology , Staphylococcal Infections/microbiology , Staphylococcus aureus/drug effects , Staphylococcus aureus/physiology , Vasculitis/microbiology , Anti-Bacterial Agents/pharmacology , Anti-Bacterial Agents/therapeutic use , Biofilms , Humans , Microbial Sensitivity Tests , Staphylococcal Infections/drug therapy , Vascular Grafting
2.
Proc Natl Acad Sci U S A ; 114(49): E10596-E10604, 2017 12 05.
Article in English | MEDLINE | ID: mdl-29158405

ABSTRACT

USA300 is a pandemic clonal lineage of hypervirulent, community-acquired, methicillin-resistant Staphylococcus aureus (CA-MRSA) with specific molecular characteristics. Despite its high clinical relevance, the evolutionary origin of USA300 remained unclear. We used comparative genomics of 224 temporal and spatial diverse S. aureus isolates of multilocus sequence type (ST) 8 to reconstruct the molecular evolution and global dissemination of ST8, including USA300. Analyses of core SNP diversity and accessory genome variations showed that the ancestor of all ST8 S. aureus most likely emerged in Central Europe in the mid-19th century. From here, ST8 was exported to North America in the early 20th century and progressively acquired the USA300 characteristics Panton-Valentine leukocidin (PVL), SCCmec IVa, the arginine catabolic mobile element (ACME), and a specific mutation in capsular polysaccharide gene cap5E Although the PVL-encoding phage ϕSa2USA was introduced into the ST8 background only once, various SCCmec types were introduced to ST8 at different times and places. Starting from North America, USA300 spread globally, including Africa. African USA300 isolates have aberrant spa-types (t112, t121) and form a monophyletic group within the clade of North American USA300. Large parts of ST8 methicillin-susceptible S. aureus (MSSA) isolated in Africa represent a symplesiomorphic group of ST8 (i.e., a group representing the characteristics of the ancestor), which are rarely found in other world regions. Isolates previously discussed as USA300 ancestors, including USA500 and a "historic" CA-MRSA from Western Australia, were shown to be only distantly related to recent USA300 clones.


Subject(s)
Evolution, Molecular , Genome, Bacterial , Methicillin-Resistant Staphylococcus aureus/genetics , Phylogeny , Staphylococcal Infections/epidemiology , Staphylococcal Infections/transmission , Africa/epidemiology , Australia/epidemiology , Bacterial Toxins/genetics , Bacterial Toxins/metabolism , Bayes Theorem , Community-Acquired Infections , Europe/epidemiology , Exotoxins/genetics , Exotoxins/metabolism , Humans , Interspersed Repetitive Sequences , Leukocidins/genetics , Leukocidins/metabolism , Methicillin-Resistant Staphylococcus aureus/classification , Methicillin-Resistant Staphylococcus aureus/isolation & purification , Methicillin-Resistant Staphylococcus aureus/pathogenicity , Multilocus Sequence Typing , North America/epidemiology , Phylogeography , Polymorphism, Single Nucleotide , Staphylococcal Infections/microbiology , Staphylococcal Infections/pathology , Type IV Secretion Systems/genetics , Type IV Secretion Systems/metabolism
3.
Clin Infect Dis ; 68(5): 854-856, 2019 02 15.
Article in English | MEDLINE | ID: mdl-30192927

ABSTRACT

Panton-Valentine leukocidin (PVL) is common in African Staphylococcus aureus and can be associated with skin and soft tissue infection. PVL-positive S. aureus colonization is associated with a variant of complement receptor 5a, the cellular target of the lukS PVL subunit.


Subject(s)
Bacterial Toxins/metabolism , Black People/genetics , Exotoxins/metabolism , Leukocidins/metabolism , Polymorphism, Single Nucleotide , Receptor, Anaphylatoxin C5a/genetics , Staphylococcus aureus/genetics , Staphylococcus aureus/physiology , Adolescent , Bacterial Toxins/genetics , Carrier State , Exotoxins/genetics , Female , Humans , Leukocidins/genetics , Male
4.
PLoS Pathog ; 13(1): e1006110, 2017 01.
Article in English | MEDLINE | ID: mdl-28081265

ABSTRACT

Most bacterial glycoproteins identified to date are virulence factors of pathogenic bacteria, i.e. adhesins and invasins. However, the impact of protein glycosylation on the major human pathogen Staphylococcus aureus remains incompletely understood. To study protein glycosylation in staphylococci, we analyzed lysostaphin lysates of methicillin-resistant Staphylococcus aureus (MRSA) strains by SDS-PAGE and subsequent periodic acid-Schiff's staining. We detected four (>300, ∼250, ∼165, and ∼120 kDa) and two (>300 and ∼175 kDa) glycosylated surface proteins with strain COL and strain 1061, respectively. The ∼250, ∼165, and ∼175 kDa proteins were identified as plasmin-sensitive protein (Pls) by mass spectrometry. Previously, Pls has been demonstrated to be a virulence factor in a mouse septic arthritis model. The pls gene is encoded by the staphylococcal cassette chromosome (SCC)mec type I in MRSA that also encodes the methicillin resistance-conferring mecA and further genes. In a search for glycosyltransferases, we identified two open reading frames encoded downstream of pls on the SCCmec element, which we termed gtfC and gtfD. Expression and deletion analysis revealed that both gtfC and gtfD mediate glycosylation of Pls. Additionally, the recently reported glycosyltransferases SdgA and SdgB are involved in Pls glycosylation. Glycosylation occurs at serine residues in the Pls SD-repeat region and modifying carbohydrates are N-acetylhexosaminyl residues. Functional characterization revealed that Pls can confer increased biofilm formation, which seems to involve two distinct mechanisms. The first mechanism depends on glycosylation of the SD-repeat region by GtfC/GtfD and probably also involves eDNA, while the second seems to be independent of glycosylation as well as eDNA and may involve the centrally located G5 domains. Other previously known Pls properties are not related to the sugar modifications. In conclusion, Pls is a glycoprotein and Pls glycosyl residues can stimulate biofilm formation. Thus, sugar modifications may represent promising new targets for novel therapeutic or prophylactic measures against life-threatening S. aureus infections.


Subject(s)
Anti-Bacterial Agents/pharmacology , Fibrinolysin/metabolism , Methicillin Resistance , Methicillin-Resistant Staphylococcus aureus/genetics , Staphylococcal Infections/microbiology , Amino Acid Sequence , Animals , Bacterial Proteins/genetics , Bacterial Proteins/metabolism , Fibrinolysin/genetics , Glycoproteins , Humans , Methicillin/pharmacology , Methicillin-Resistant Staphylococcus aureus/drug effects , Mice , Virulence Factors
5.
Int J Med Microbiol ; 309(5): 283-287, 2019 Jul.
Article in English | MEDLINE | ID: mdl-31122879

ABSTRACT

BACKGROUND: Staphylococcus aureus is one of the most frequently isolated pathogens in the respiratory tract of CF patients. Recently, we characterized peculiar mucoid S. aureus isolates, which are excessive biofilm formers and which carried a 5bp-deletion within the intergenic region of the ica operon. In this prospective study, we determined the prevalence of mucoid S. aureus-isolates in the airways of CF-patients during a 3-months period. METHODS: We analyzed specimens (sputa, throat swabs) from 81 CF patients who attended two CF centers in Münster, Germany. Ten S. aureus isolates were randomly picked from every S. aureus-positive airway specimen and evaluated for mucoidy using Congo Red agar and phenotypic tests. Mucoid isolates were characterized by spa sequence typing, biofilm production and sequencing of the intergenic region of the ica operon to screen for the 5bp-deletion. RESULTS: In 7 of 81 examined patients (8.6%), we detected mucoid S. aureus phenotypes (37 out of 1050 isolates; 3.5%). Twenty-five mucoid isolates carried the 5bp-deletion. Mucoid isolates produced excessive biofilm and were significantly more resistant to certain antibiotics. CONCLUSIONS: In our prospective study, mucoid S. aureus was present in 8.6% of S. aureus-positive CF-patients. In 6 of 7 patients, mucoid isolates carried the 5bp-deletion, indicating that also other so far not identified mechanisms cause excessive biofilm formation. Further studies are necessary to ascertain the clinical impact of mucoid S. aureus phenotypes on the severity of the CF disease.


Subject(s)
Cystic Fibrosis/microbiology , Polysaccharides, Bacterial/metabolism , Staphylococcus aureus/isolation & purification , Adolescent , Adult , Anti-Bacterial Agents/pharmacology , Biofilms , Child , Female , Germany , Humans , Male , Phenotype , Prevalence , Prospective Studies , Staphylococcal Infections/microbiology , Staphylococcus aureus/drug effects , Staphylococcus aureus/genetics , Young Adult
6.
FASEB J ; 32(5): 2779-2793, 2018 05.
Article in English | MEDLINE | ID: mdl-29401589

ABSTRACT

Superinfections with Staphylococcus aureus are a major complication of influenza disease, causing excessive inflammation and tissue damage. This enhanced cell-damaging effect is also observed in superinfected tissue cultures, leading to a strong decrease in overall cell viability. In our analysis of the underlying molecular mechanisms, we observed that, despite enhanced cell damage in superinfection, S. aureus did not increase but rather inhibited influenza virus (IV)-induced apoptosis in cells on the level of procaspase-8 activation. This apparent contradiction was solved when we observed that S. aureus mediated a switch from apoptosis to necrotic cell death of IV-infected cells, a mechanism that was dependent on the bacterial accessory gene regulator ( agr) locus that promotes bacterial survival and spread. This so far unknown action may be a bacterial strategy to enhance dissemination of intracellular S. aureus and may thereby contribute to increased tissue damage and severity of disease.-Van Krüchten, A., Wilden, J. J., Niemann, S., Peters, G., Löffler, B., Ludwig, S., Ehrhardt, C. Staphylococcus aureus triggers a shift from influenza virus-induced apoptosis to necrotic cell death.


Subject(s)
Apoptosis/immunology , Human Umbilical Vein Endothelial Cells , Influenza A Virus, H1N1 Subtype/immunology , Influenza, Human , Staphylococcal Infections , Staphylococcus aureus/immunology , Animals , Caspase 8/immunology , Dogs , Human Umbilical Vein Endothelial Cells/immunology , Human Umbilical Vein Endothelial Cells/microbiology , Human Umbilical Vein Endothelial Cells/pathology , Human Umbilical Vein Endothelial Cells/virology , Humans , Influenza, Human/immunology , Influenza, Human/microbiology , Influenza, Human/pathology , Madin Darby Canine Kidney Cells , Necrosis , Staphylococcal Infections/immunology , Staphylococcal Infections/pathology , Staphylococcal Infections/virology
8.
Emerg Infect Dis ; 24(2): 242-248, 2018 02.
Article in English | MEDLINE | ID: mdl-29350135

ABSTRACT

During cefoxitin-based nasal screening, phenotypically categorized methicillin-resistant Staphylococcus aureus (MRSA) was isolated and tested negative for the presence of the mecA and mecC genes as well as for the SCCmec-orfX junction region. The isolate was found to carry a mecB gene previously described for Macrococcus caseolyticus but not for staphylococcal species. The gene is flanked by ß-lactam regulatory genes similar to mecR, mecI, and blaZ and is part of an 84.6-kb multidrug-resistance plasmid that harbors genes encoding additional resistances to aminoglycosides (aacA-aphD, aphA, and aadK) as well as macrolides (ermB) and tetracyclines (tetS). This further plasmidborne ß-lactam resistance mechanism harbors the putative risk of acceleration or reacceleration of MRSA spread, resulting in broad ineffectiveness of ß-lactams as a main therapeutic application against staphylococcal infections.


Subject(s)
Bacterial Proteins/genetics , Methicillin Resistance/genetics , Methicillin-Resistant Staphylococcus aureus/genetics , Plasmids/genetics , Aged , Gene Transfer, Horizontal , Humans , Male
9.
Article in English | MEDLINE | ID: mdl-29378720

ABSTRACT

The Staphylococcus aureus small-colony variant (SCV) phenotype has been associated with relapsing and antibiotic-refractory infections. However, little is known about the activities of antibiotics on clinical SCVs. Here, we demonstrated that SCVs without detectable auxotrophies were at least as susceptible to most ß-lactam and non-ß-lactam antibiotics in vitro as their corresponding clonally identical strains with a normal phenotype. After prolonged incubation, a regrowth phenomenon has been observed in gradient diffusion inhibition zones irrespective of the strains' phenotype.


Subject(s)
Staphylococcus aureus/drug effects , beta-Lactams/pharmacology , Anti-Bacterial Agents/pharmacology , Daptomycin/pharmacology , Lincosamides/pharmacology , Linezolid/pharmacology , Microbial Sensitivity Tests , Trimethoprim/pharmacology
10.
Article in English | MEDLINE | ID: mdl-29735560

ABSTRACT

Livestock-associated methicillin-resistant Staphylococcus aureus (LA-MRSA) isolates are increasingly migrating from livestock into human and animal health care settings. Alternative substances are needed to overcome the drawbacks of currently available drugs used for MRSA eradication. The recombinant bacteriophage endolysin HY-133 has proved to be an active agent against S. aureus Here, the in vitro activity of HY-133 was studied against a large collection of genetically diverse LA-MRSA isolates revealing its high activity against mecA-, mecB-, and mecC-positive LA-MRSA.


Subject(s)
Anti-Bacterial Agents/pharmacology , Bacteriophages/metabolism , Endopeptidases/pharmacology , Methicillin-Resistant Staphylococcus aureus/drug effects , Recombinant Proteins/pharmacology , Adenosine Triphosphatases/genetics , Animals , Bacterial Proteins/genetics , Humans , Livestock , Methicillin-Resistant Staphylococcus aureus/isolation & purification , Microbial Sensitivity Tests , Penicillin-Binding Proteins/genetics , Staphylococcal Infections/drug therapy , Staphylococcal Infections/veterinary
11.
PLoS Pathog ; 12(11): e1006024, 2016 Nov.
Article in English | MEDLINE | ID: mdl-27902784

ABSTRACT

Cystic fibrosis (CF) is associated with chronic bacterial airway infections leading to lung insufficiency and decreased life expectancy. Staphylococcus aureus is one of the most prevalent pathogens isolated from the airways of CF patients. Mucoid colony morphology has been described for Pseudomonas aeruginosa, the most common pathogen in CF, but not for S. aureus. From the airways of 8 of 313 CF patients (2.5%) mucoid S. aureus isolates (n = 115) were cultured with a mean persistence of 29 months (range 1 month, 126 months). In contrast to non-mucoid S. aureus, mucoid isolates were strong biofilm formers. The upstream region of the ica operon, which encodes the proteins responsible for the synthesis of the polysaccharide intercellular adhesin (PIA), of mucoid isolates was sequenced. Spa-types of mucoid and non-mucoid strains were identical, but differed between patients. Mucoid isolates carried a 5 bp deletion in the intergenic region between icaR and icaA. During long-term persistence, from two patients subsequent non-mucoid isolates (n = 12) with 5 bp deletions were cultured, which did not produce biofilm. Sequencing of the entire ica operon identified compensatory mutations in various ica-genes including icaA (n = 7), icaD (n = 3) and icaC (n = 2). Six sequential isolates of each of these two patients with non-mucoid and mucoid phenotypes were subjected to whole genome sequencing revealing a very close relationship of the individual patient's isolates. Transformation of strains with vectors expressing the respective wild-type genes restored mucoidy. In contrast to the non-mucoid phenotype, mucoid strains were protected against neutrophilic killing and survived better under starvation conditions. In conclusion, the special conditions present in CF airways seem to facilitate ongoing mutations in the ica operon during S. aureus persistence.


Subject(s)
Bacterial Proteins/genetics , Cystic Fibrosis/microbiology , Staphylococcal Infections/genetics , Staphylococcal Infections/pathology , Biofilms , Humans , Microscopy, Confocal , Multiplex Polymerase Chain Reaction , Mutation , Operon/genetics , Staphylococcus aureus
12.
Int J Med Microbiol ; 308(6): 631-639, 2018 Aug.
Article in English | MEDLINE | ID: mdl-29501453

ABSTRACT

BACKGROUND: Cystic fibrosis (CF) is an autosomal recessive disease associated with chronic airway infections by Staphylococcus aureus as one of the earliest and most prevalent pathogens. We conducted a retrospective study to determine the S. aureus infection status of CF patients treated since 1994 at two certified CF-centres in Münster, Germany, to get insights into the dynamics of S. aureus airway infection and the clinical impact on lung function on a long-term perspective. MATERIALS AND METHODS: We used data from our microbiological database collected between 1994 and 2016 for patients treated at two centres in Münster, Germany, respectively, to determine the infection status for S. aureus. Furthermore, the resistance to selected antibiotics was determined for all patients' isolates and for 15 patients on a longitudinal basis. In addition, the prevalence of adaptive phenotypes such as small colony variants (SCVs) and mucoid S. aureus was assessed. RESULTS: For this study, 2867 patient years with respiratory specimens (mean of 9.3 years for every patient, range 1-22 years) were evaluated for 283 CF patients (median age of 7 years at the beginning of the observation period, range 0-57 years, 51% male). 18% of patients were rarely infected by S. aureus (≤24% of observation years), 20% of patients intermittently (25-49%) and 61% persistently (≥50% of observation period). Susceptibility testing for 12969 S. aureus isolates resulted in resistance to methicillin in 9%, trimethoprim/sulfamethoxazole in 10%, levofloxacin in 14%, gentamicin in 20%, erythromycin and/or clindamycin in 30% and penicillin in 80% of all isolates. S. aureus isolates of 15 patients revealed dynamics of resistance with increase, decrease and loss of resistant isolates to the analysed antibiotics during the study period. SCVs were isolated at least once from 42% (n = 118) of patients and mucoid isolates from 2% (n = 7) of patients. In the last study year, 89 patients were infected by S. aureus only, 44 patients by S. aureus and Pseudomonas aeruginosa and 18 by P. aeruginosa only. Patients infected by S. aureus only were younger and had better lung function compared to the other two groups. CONCLUSIONS: We determined a high percentage of patients with persistent S. aureus infection. During persistence, mostly fluctuation of resistance against various antibiotics was observed in the isolates indicating acquisition and loss of resistance genes by S. aureus. The prevalence of adaptive phenotypes during long-term persistence was high for SCVs (42% of patients), but low for mucoid isolates (2% of patients), which might be underestimated for mucoid phenotypes due to the retrospective study design and the difficulty to detect mucoid isolates in primary cultures. While patients with S. aureus only had better lung function and were younger, no difference was found between the group of P. aeruginosa and S. aureus co-infection and P. aeruginosa only with previous S. aureus infection.


Subject(s)
Coinfection/microbiology , Cystic Fibrosis/microbiology , Respiratory System/microbiology , Staphylococcal Infections/epidemiology , Staphylococcus aureus/isolation & purification , Adolescent , Adult , Anti-Bacterial Agents/therapeutic use , Child , Child, Preschool , Coinfection/epidemiology , Cystic Fibrosis/complications , Female , Germany , Humans , Infant , Longitudinal Studies , Male , Middle Aged , Phenotype , Prevalence , Pseudomonas aeruginosa/isolation & purification , Respiratory Function Tests , Respiratory System/physiopathology , Retrospective Studies , Staphylococcal Infections/drug therapy , Young Adult
13.
Int J Med Microbiol ; 308(7): 761-769, 2018 Oct.
Article in English | MEDLINE | ID: mdl-29843979

ABSTRACT

Staphylococcus aureus is the most frequent pathogen causing diabetic foot infections. Here, we investigated the degree of bacterial virulence required to establish invasive tissue infections in diabetic organisms. Staphylococcal isolates from diabetic and non-diabetic foot ulcers were tested for their virulence in in vitro functional assays of host cell invasion and cytotoxicity. Isolates from diabetes mellitus type I/II patients exhibited less virulence than isolates from non-diabetic patients, but were nevertheless able to establish severe infections. In some cases, non-invasive isolates were detected deep within diabetic wounds, even though the strains were non-pathogenic in cell culture models. Testing of defined isolates in murine footpad injection models revealed that both low- and high-virulent bacterial strains persisted in higher numbers in diabetic compared to non-diabetic hosts, suggesting that hyperglycemia favors bacterial survival. Additionally, the bacterial load was higher in NOD mice, which have a compromised immune system, compared to C57Bl/6 mice. Our results reveal that high as well as low-virulent staphylococcal strains are able to cause soft tissue infections and to persist in diabetic humans and mice, suggesting a reason for the frequent and endangering infections in patients with diabetes.


Subject(s)
Bacterial Load , Diabetes Mellitus, Experimental/pathology , Diabetic Foot/microbiology , Soft Tissue Infections/microbiology , Staphylococcus aureus/pathogenicity , Adult , Aged , Animals , Cells, Cultured , Human Umbilical Vein Endothelial Cells , Humans , Hyperglycemia/metabolism , Mice , Mice, Inbred C57BL , Mice, Inbred NOD , Middle Aged , Staphylococcus aureus/isolation & purification , Streptozocin , Virulence
14.
Am J Pathol ; 187(2): 268-279, 2017 Feb.
Article in English | MEDLINE | ID: mdl-28088288

ABSTRACT

Staphylococcus aureus causes very serious infections of vascular grafts. Knowledge of the molecular mechanisms of this disease is largely lacking because of the absence of representable models. Therefore, the aim of this study was to set up a mouse model of vascular graft infections that closely mimics the human situation. A catheter was inserted into the right carotid artery of mice, which acted as a vascular graft. Mice were infected i.v. using 8 different S. aureus strains, and development of the infection was followed up. Although all strains had varying abilities to form biofilm in vitro and different levels of virulence in mice, they all caused biofilm formation on the grafts. This graft infection was monitored using magnetic resonance imaging (MRI) and 18F-fluordeoxyglucose positron emission tomography (FDG-PET). MRI allowed the quantification of blood flow through the arteries, which was decreased in the catheter after infection. FDG-PET revealed high inflammation levels at the site of the catheter after infection. This model closely resembles the situation in patients, which is characterized by a tight interplay between pathogen and host, and can therefore be used for the testing of novel treatment, diagnosis, and prevention strategies. In addition, combining MRI and PET with microscopic techniques provides an appropriate way to characterize the course of these infections and to precisely analyze biofilm development.


Subject(s)
Biofilms/growth & development , Catheter-Related Infections/diagnostic imaging , Disease Models, Animal , Staphylococcal Infections/diagnostic imaging , Animals , Blood Vessel Prosthesis/microbiology , Enzyme-Linked Immunosorbent Assay , In Situ Hybridization, Fluorescence , Magnetic Resonance Imaging , Mice , Microscopy, Confocal , Microscopy, Electron, Transmission , Positron-Emission Tomography , Staphylococcus aureus
15.
Curr Top Microbiol Immunol ; 409: 229-261, 2017.
Article in English | MEDLINE | ID: mdl-27380269

ABSTRACT

Musculoskeletal infections caused by Staphylococcus aureus are among the most difficult-to-treat infections. S. aureus osteomyelitis is associated with a tremendous disease burden through potential for long-term relapses and functional deficits. Although considerable advances have been achieved in diagnosis and treatment of osteomyelitis, the management remains challenging and impact on quality of life is still enormous. S. aureus acute arthritis is relatively seldom in general population, but the incidence is considerably higher in patients with predisposing conditions, particularly those with rheumatoid arthritis. Rapidly destructive course with high mortality and disability rates makes urgent diagnosis and treatment of acute arthritis essential. S. aureus pyomyositis is a common disease in tropical countries, but it is very seldom in temperate regions. Nevertheless, the cases have been increasingly reported also in non-tropical countries, and the physicians should be able to timely recognize this uncommon condition and initiate appropriate treatment. The optimal management of S. aureus-associated musculoskeletal infections requires a strong interdisciplinary collaboration between all involved specialists.


Subject(s)
Osteomyelitis , Pyomyositis , Staphylococcal Infections , Humans , Quality of Life , Staphylococcus aureus
16.
Infection ; 46(3): 395-404, 2018 Jun.
Article in English | MEDLINE | ID: mdl-29667040

ABSTRACT

PURPOSE: The incidence of Staphylococcus aureus skin and soft tissue infection (SSTI) is high in sub-Saharan Africa. This is fueled by a high prevalence of Panton-Valentine leukocidin (PVL), which can be associated with necrotizing disease. The aim was to describe the clinical presentation and the treatment of SSTI in the African setting and to identify challenges in the management. METHODS: Patients (n = 319) were recruited in DR Congo (n = 56, 17.6%), Gabon (n = 89, 27.9%), Mozambique (n = 79, 24.8%) and Tanzania (n = 95, 29.8%) during the prospective observational StaphNet cohort study (2010-2015). A physician recorded the clinical management in standardized questionnaires and stratified the entity of SSTI into superficial (sSSTI) or deep-seated (dSSTI). Selected virulence factors (PVL, ß hemolysin) and multilocus sequence types (MLST) were extracted from whole genome sequencing data. RESULTS: There were 220/319 (69%) sSSTI and 99/319 (31%) dSSTI. Compared to sSSTI, patients with dSSTI were more often hospitalized (13.2 vs. 23.5%, p = 0.03), HIV-positive (7.6 vs. 15.9%, p = 0.11), and required more often incision and drainage (I&D, 45.5 vs. 76.5%, p = 0.04). The proportion of an adequate antimicrobial therapy increased marginally from day 1 (empirical therapy) to day 3 (definite therapy), for sSSTI (70.7 to 72.4%) and dSSTI (55.4 to 58.9%). PVL was a risk factor for I&D (OR = 1.7, p = 0.02) and associated with MLST clonal complex CC121 (OR = 2.7, p < 0.001). CONCLUSION: Appropriate antimicrobial agents and surgical services to perform I&D were available for the majority of patients. Results from susceptibility testing should be considered more efficiently in the selection of antimicrobial therapy.


Subject(s)
Anti-Bacterial Agents/therapeutic use , Soft Tissue Infections , Staphylococcal Infections , Staphylococcus aureus/isolation & purification , Adolescent , Adult , Africa South of the Sahara , Aged , Aged, 80 and over , Child , Child, Preschool , Cohort Studies , Female , Humans , Infant , Infant, Newborn , Male , Middle Aged , Soft Tissue Infections/diagnosis , Soft Tissue Infections/drug therapy , Soft Tissue Infections/microbiology , Soft Tissue Infections/surgery , Staphylococcal Infections/diagnosis , Staphylococcal Infections/drug therapy , Staphylococcal Infections/microbiology , Staphylococcal Infections/surgery , Staphylococcal Skin Infections/diagnosis , Staphylococcal Skin Infections/drug therapy , Staphylococcal Skin Infections/microbiology , Staphylococcal Skin Infections/surgery , Young Adult
17.
PLoS Pathog ; 11(4): e1004870, 2015 Apr.
Article in English | MEDLINE | ID: mdl-25923704

ABSTRACT

Staphylococcus aureus is a major human pathogen that causes a range of infections from acute invasive to chronic and difficult-to-treat. Infection strategies associated with persisting S. aureus infections are bacterial host cell invasion and the bacterial ability to dynamically change phenotypes from the aggressive wild-type to small colony variants (SCVs), which are adapted for intracellular long-term persistence. The underlying mechanisms of the bacterial switching and adaptation mechanisms appear to be very dynamic, but are largely unknown. Here, we analyzed the role and the crosstalk of the global S. aureus regulators agr, sarA and SigB by generating single, double and triple mutants, and testing them with proteome analysis and in different in vitro and in vivo infection models. We were able to demonstrate that SigB is the crucial factor for adaptation in chronic infections. During acute infection, the bacteria require the simultaneous action of the agr and sarA loci to defend against invading immune cells by causing inflammation and cytotoxicity and to escape from phagosomes in their host cells that enable them to settle an infection at high bacterial density. To persist intracellularly the bacteria subsequently need to silence agr and sarA. Indeed agr and sarA deletion mutants expressed a much lower number of virulence factors and could persist at high numbers intracellularly. SigB plays a crucial function to promote bacterial intracellular persistence. In fact, ΔsigB-mutants did not generate SCVs and were completely cleared by the host cells within a few days. In this study we identified SigB as an essential factor that enables the bacteria to switch from the highly aggressive phenotype that settles an acute infection to a silent SCV-phenotype that allows for long-term intracellular persistence. Consequently, the SigB-operon represents a possible target to develop preventive and therapeutic strategies against chronic and therapy-refractory infections.


Subject(s)
Bacterial Proteins/metabolism , Endothelium, Vascular/microbiology , Host-Pathogen Interactions , Neutrophils/microbiology , Osteoblasts/microbiology , Sigma Factor/metabolism , Staphylococcal Infections/microbiology , Staphylococcus aureus/physiology , Adaptation, Physiological , Animals , Bacterial Proteins/genetics , Cell Line , Cells, Cultured , Endothelium, Vascular/cytology , Endothelium, Vascular/immunology , Endothelium, Vascular/pathology , Gene Deletion , Human Umbilical Vein Endothelial Cells/cytology , Human Umbilical Vein Endothelial Cells/immunology , Human Umbilical Vein Endothelial Cells/microbiology , Human Umbilical Vein Endothelial Cells/pathology , Humans , Mice , Mice, Inbred BALB C , Mutation , Neutrophils/cytology , Neutrophils/immunology , Neutrophils/pathology , Osteoblasts/cytology , Osteoblasts/immunology , Osteoblasts/pathology , Proteomics , Sigma Factor/genetics , Staphylococcal Infections/immunology , Staphylococcal Infections/metabolism , Staphylococcal Infections/pathology , Staphylococcus aureus/immunology , Staphylococcus aureus/metabolism , Time Factors , Trans-Activators/genetics , Trans-Activators/metabolism
18.
J Immunol ; 194(3): 1100-11, 2015 Feb 01.
Article in English | MEDLINE | ID: mdl-25548227

ABSTRACT

Staphylococcus aureus can cause difficult-to-treat chronic infections. We recently reported that S. aureus chronic infection was associated with a profound inhibition of T cell responses. In this study, we investigated the mechanisms responsible for the suppression of T cell responses during chronic S. aureus infection. Using in vitro coculture systems, as well as in vivo adoptive transfer of CFSE-labeled OT-II cells, we demonstrated the presence of immunosuppressive mechanisms in splenocytes of S. aureus-infected mice that inhibited the response of OT-II cells to cognate antigenic stimulation. Immunosuppression was IL-10/TGF-ß independent but required cell-cell proximity. Using DEREG and Foxp3(gfp) mice, we demonstrated that CD4(+)CD25(+)Foxp3(+) regulatory T cells contributed, but only to a minor degree, to bystander immunosuppression. Neither regulatory B cells nor tolerogenic dendritic cells contributed to immunosuppression. Instead, we found a significant expansion of granulocytic (CD11b(+)Ly6G(+)Ly6C(low)) and monocytic (CD11b(+)Ly6G(-)Ly6C(high)) myeloid-derived suppressor cells (MDSC) in chronically infected mice, which exerted a strong immunosuppressive effect on T cell responses. Splenocytes of S. aureus-infected mice lost most of their suppressive activity after the in vivo depletion of MDSC by treatment with gemcitabine. Furthermore, a robust negative correlation was observed between the degree of T cell inhibition and the number of MDSC. An increase in the numbers of MDSC in S. aureus-infected mice by adoptive transfer caused a significant exacerbation of infection. In summary, our results indicate that expansion of MDSC and, to a minor degree, of regulatory T cells in S. aureus-infected mice may create an immunosuppressive environment that sustains chronic infection.


Subject(s)
Immunomodulation , Myeloid Cells/immunology , Staphylococcal Infections/immunology , Staphylococcus aureus/immunology , T-Lymphocytes, Regulatory/immunology , Adoptive Transfer , Animals , B-Lymphocytes, Regulatory/immunology , B-Lymphocytes, Regulatory/metabolism , Cell Communication , Coculture Techniques , Cytokines/biosynthesis , Dendritic Cells/immunology , Disease Models, Animal , Female , Immune Tolerance/immunology , Immunophenotyping , Mice , Mice, Transgenic , Phenotype , Severity of Illness Index , Spleen/cytology , Spleen/immunology , Staphylococcal Infections/metabolism , T-Lymphocyte Subsets/immunology , T-Lymphocyte Subsets/metabolism , T-Lymphocytes, Regulatory/metabolism
19.
Antimicrob Agents Chemother ; 60(4): 2551-3, 2016 Apr.
Article in English | MEDLINE | ID: mdl-26833148

ABSTRACT

HY-133 is a recombinant bacteriophage endolysin with bactericidal activity againstStaphylococcus aureus Here, HY-133 showedin vitroactivity against major African methicillin-susceptible and methicillin-resistantS. aureuslineages and ceftaroline/ceftobiprole- and borderline oxacillin-resistant isolates. HY-133 was also active againstStaphylococcus schweitzeri, a recently described species of theS. aureuscomplex. The activity of HY-133 on the tested isolates (MIC50, 0.25 µg/ml; MIC90, 0.5 µg/ml; range, 0.125 to 0.5 µg/ml) was independent of the species and strain background or antibiotic resistance.


Subject(s)
Anti-Bacterial Agents/pharmacology , Endopeptidases/pharmacology , Recombinant Proteins/pharmacology , Staphylococcus Phages/metabolism , Staphylococcus aureus/drug effects , Staphylococcus/drug effects , Africa , Anti-Bacterial Agents/biosynthesis , Cephalosporins/pharmacology , Endopeptidases/biosynthesis , Endopeptidases/genetics , Humans , Methicillin Resistance/genetics , Microbial Sensitivity Tests , Recombinant Proteins/biosynthesis , Recombinant Proteins/genetics , Staphylococcal Infections/microbiology , Staphylococcus/growth & development , Staphylococcus/isolation & purification , Staphylococcus aureus/growth & development , Staphylococcus aureus/isolation & purification , beta-Lactam Resistance/genetics , Ceftaroline
20.
Environ Microbiol ; 18(7): 2130-42, 2016 07.
Article in English | MEDLINE | ID: mdl-25923378

ABSTRACT

The complex anatomy of the human nose might offer distinct microbial niches. Microbiota composition may affect nose inflammatory diseases and Staphylococcus aureus carriage. Considering different nasal cavity locations, microbial colonization was analysed across individuals exhibiting chronic nasal inflammatory diseases (n = 18) and those without local inflammation signs (n = 16). Samples were collected systematically during surgery and examined by an extensive culture-based approach and, for a subset, by 16S rRNA gene community profiling. Cultivation yielded 141 taxa with members of Staphylococcus, Corynebacterium and Propionibacterium as most common isolates comprising the nasal core culturome together with Finegoldia magna. Staphylococcus aureus was most frequently found in association with Staphylococcus epidermidis and Propionibacterium acnes, and the posterior vestibules were redefined as S. aureus' principle habitat. Culturome analysis revealed host-specific bacterial 'fingerprints' irrespective of host-driven factors or intranasal sites. Comparisons between cultivable and molecular fingerprints demonstrated that only a small fraction of phylotypes (6.2%) was correlated. While the total number of different phylotypes was higher in the molecular dataset, the total number of identifications down to the species level was higher in the culturomic approach. To determine host-specific microbiomes, the advantages of molecular approaches should be combined with the resolution and reliability of species identification by culturomic analyses.


Subject(s)
Bacteria/isolation & purification , Microbiota , Nasal Cavity/microbiology , Adult , Aged , Bacteria/classification , Bacteria/genetics , Bacteria/growth & development , Female , Humans , Male , Middle Aged , Phylogeny , Young Adult
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