Primary community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) endocarditis has rarely been reported in healthy individuals without risk factors, such as skin and soft tissue infections, and intravenous drug abuse. We describe a case of infective endocarditis by CA-MRSA (ST72-PVL negative-SCCmec IVA) in previously healthy individuals with no underlying medical condition and CA-MRSA colonization in the family.
Adult ; Community-Acquired Infections/microbiology/transmission ; Endocarditis/*microbiology ; Family ; Female ; Humans ; *Methicillin Resistance ; Staphylococcal Infections/*diagnosis/drug therapy/*transmission ; Staphylococcus aureus/*drug effects

PURPOSE: The aim of this study was to identify the present situation of hospital infection and route of infection by clarifying the transmission aspect of methicillin-resistant Staphylococcus aureus(MRSA) in a Neurosurgical Intensive Care Unit by analysing genotype. METHODS: MRSA was cultured from twenty five patients with a tracheostomy, twenty five health care workers, and environments in the Neurosurgical Intensive Care Unit of one hospital in D city. Data was collected from December 21, 2004 to November 5, 2005. MRSA isolates representing each genotype were analyzed by spaA typing and a multiplex PCR method capable of identifying the structural type of the staphylococcal cassette chromosome mec(SCCmec) carried by the bacteria. RESULTS: As the same genotype and gene sequence were found among health care workers, patients, and environments, it was assumed that there was cross transmission among them. CONCLUSION: This study suggests that first, as the hospital infection by MRSA between health care workers and patients in the Neurosurgical Intensive Care Unit was due to result of cross transmission and the relevance of transmission between them was verified, it is necessary to take preventive measures and conduct education. Secondly, development of nursing interventions and study of infection are needed. Thirdly, consistent investment in prevention against hospital infections and environmental renovation is needed.
Bacterial Proteins/genetics ; Drug Resistance, Bacterial ; Genotype ; Humans ; *Infectious Disease Transmission, Patient-to-Professional ; *Infectious Disease Transmission, Professional-to-Patient ; Intensive Care Units ; *Methicillin Resistance ; Neurosurgery ; Polymerase Chain Reaction ; Staphylococcal Infections/microbiology/*transmission ; Staphylococcus aureus/drug effects/genetics/*isolation & purification ; Tracheostomy

OBJECTIVETo investigate the relation between the epidemiological strains of meticillin-resistant Staphylococcus aureus (MRSA) and the strains isolated from the nasal fossa of the medical staff and inpatients.

METHODSThe MRSA strains were isolated from the nasal fossa of the medical staff and inpatients in the Department of Neurosurgery. The genes of the isolated strains were amplified by randomly amplified polymorphic DNA (RAPD) assay.

RESULTSThree and 12 MRSA strains were isolated from the nasal fossa of the medical staff and patients who were hospitalized for more than 1 week, respectively, and RAPD assay revealed high homology between the isolated strains.

CONCLUSIONCross infection can be present between the medical staff, inpatients, and the infected patients.

China ; epidemiology ; Cross Infection ; microbiology ; DNA, Bacterial ; genetics ; isolation & purification ; Humans ; Infectious Disease Transmission, Professional-to-Patient ; Inpatients ; Medical Staff ; Methicillin Resistance ; Nasal Cavity ; microbiology ; Phylogeny ; Random Amplified Polymorphic DNA Technique ; Staphylococcal Infections ; epidemiology ; microbiology ; Staphylococcus aureus ; classification ; genetics ; isolation & purification

BACKGROUNDGram-positive bacteria such as Staphylococcus aureus have been a common cause of infection among liver transplant (LT) recipients in recent decades. The understanding of local epidemiology and its evolving trends with regard to pathogenic spectra and antibiotic susceptibility is beneficial to prophylactic and empiric treatment for LT recipients. This study aimed to investigate etiology, timing, antibiotic susceptibility and risk factors for multidrug resistant (MDR) Gram-positive coccal bacteremia after LT.

METHODSA cohort analysis of prospectively recorded data was performed to investigate etiologies, timing, antibiotic susceptibility and risk factors for MDR Gram-positive coccal bacteremia in 475 LT recipients.

RESULTSIn 475 LT recipients in the first six months after LT, there were a total of 98 episodes of bacteremia caused by Gram-positive cocci in 82 (17%) patients. Seventy-five (77%) bacteremic episodes occurred in the first post-LT month. The most frequent Gram-positive cocci were methicillin-resistant coagulase-negative staphylococcus (CoNS, 46 isolates), methicillin-resistant Staphylococcus aureus (MRSA, 13) and enterococcus (34, E. faecium 30, E. faecalis 4). In all Gram-positive bacteremic isolates, 59 of 98 (60%) were MDR. Gram-positive coccal bacteremia and MDR Gram-positive coccal bacteremia predominantly occurred in patients with acute severe exacerbation of chronic hepatitis B and with fulminant/subfulminant hepatitis. Four independent risk factors for development of bacteremia caused by MDR Gram-positive coccus were: LT candidates with encephalopathy grades II - IV (P = 0.013, OR: 16.253, 95%CI: 1.822 - 144.995), pre-LT use of empirical antibiotics (P = 0.018, OR: 1.029, 95%CI: 1.002 - 1.057), post-LT urinary tract infections (P < 0.001, OR: 20.340, 95%CI: 4.135 - 100.048) and abdominal infection (P = 0.004, OR: 2.820, 95%CI: 1.122 - 10.114). The main infectious manifestations were coinfections due to gram-positive cocci and gram-negative bacilli.

CONCLUSIONSMethicillin-resistant CoNS and enterococci are predominant pathogens among LT recipients with Gram-positive coccal bacteremia. Occurrences of Gram-positive coccal bacteremia may be associated with the severity of illness in the perioperative stage.

Anti-Bacterial Agents ; pharmacology ; Bacteremia ; etiology ; microbiology ; Coagulase ; metabolism ; Drug Resistance, Multiple, Bacterial ; Enterococcus ; drug effects ; enzymology ; physiology ; Gram-Positive Bacterial Infections ; enzymology ; microbiology ; transmission ; Humans ; Liver Diseases ; microbiology ; Liver Transplantation ; adverse effects ; Risk Factors ; Staphylococcal Infections ; enzymology ; microbiology ; transmission ; Staphylococcus ; drug effects ; enzymology ; physiology

BACKGROUND/AIMS: Liver transplant patients are at high risk for methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE) colonization. We evaluated patients before and after liver transplant using active surveillance culture (ASC) to assess the prevalence of MRSA and VRE and to determine the effect of bacterial colonization on patient outcome. METHODS: We performed ASC on 162 liver transplant recipients at the time of transplantation and 7 days posttransplantation to monitor the prevalence of MRSA and VRE. RESULTS: A total of 142 patients had both nasal and rectal ASCs. Of these patients, MRSA was isolated from 12 (7.4%) at the time of transplantation (group 1a), 9 (6.9%) acquired MRSA posttransplantation (group 2a), and 121 did not test positive for MRSA at either time (group 3a). Among the three groups, group 1a patients had the highest frequency of developing a MRSA infection (p < 0.01); however, group 2a patients had the highest mortality rate associated with MRSA infection (p = 0.05). Of the 142 patients, VRE colonization was detected in 37 patients (22.8%) at the time of transplantation (group 1b), 21 patients (20%) acquired VRE posttransplantation (group 2b), and 84 patients did not test positive for VRE at either time (group 3b). Among these three groups, group 2b patients had the highest frequency of VRE infections (p < 0.01) and mortality (p = 0.04). CONCLUSIONS: Patients that acquired VRE or MRSA posttransplantation had higher mortality rates than did those who were colonized pre-transplantation or those who never acquired the pathogens. Our findings highlight the importance of preventing the acquisition of MRSA and VRE posttransplantation to reduce infections and mortality among liver transplant recipients.
Adult ; Enterococcus/*isolation & purification ; Female ; Gram-Positive Bacterial Infections/diagnosis/*microbiology/mortality/transmission ; Humans ; Liver Transplantation/*adverse effects/mortality ; Male ; Methicillin-Resistant Staphylococcus aureus/*isolation & purification ; Middle Aged ; Prevalence ; Prospective Studies ; Republic of Korea/epidemiology ; Risk Factors ; Staphylococcal Infections/diagnosis/*microbiology/mortality/transmission ; Time Factors ; Treatment Outcome ; *Vancomycin Resistance