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Review paper
Received: 28.04.2015. >> Accepted: 19.06.2015. >> Published: 18.04.2015. Biochemistry
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https://doi.org/10.17392/816-15

Methicillin-resistant S. aureus (MRSA), extended-spectrum (ESBL)- and plasmid-mediated AmpC ß-lactamase -producing Gram-negative bacteria associated with skin and soft tissue infections in hospital and community settings

By
Selma Uzunović ,
Selma Uzunović
Contact Selma Uzunović

Department of Laboratory Diagnostics, Cantonal Public Health Institute of Zenica-Doboj Canton , Zenica , Bosnia and Herzegovina

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Branka Bedenić ,
Branka Bedenić

School of Medicine, University of Zagreb , Zagreb , Croatia

Department of Molecular Microbiology, Clinical Hospital Center Zagreb , Zagreb , Croatia

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Ana Budimir ,
Ana Budimir

Department of Molecular Microbiology, Clinical Hospital Center Zagreb , Zagreb , Croatia

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Amir Ibrahimagić ,
Amir Ibrahimagić

Department of Laboratory Diagnostics, Cantonal Public Health Institute of Zenica-Doboj Canton , Zenica , Bosnia and Herzegovina

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Farah Kamberović ,
Farah Kamberović

Microbiology Department, Biotechnical Faculty, University of Ljubljana , Ljubljana , Slovenia

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Zlatko Fiolić ,
Zlatko Fiolić

Department of Surgery, Clinical Hospital Center Zagreb , Zagreb , Croatia

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Michelle I. A. Rijnders ,
Michelle I. A. Rijnders

Department of Medical Microbiology, School for Public Health and Primary Care (CAPHRI), Maastricht University Medical Center , Mastricht , Netherlands

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Ellen E. Stobberingh
Ellen E. Stobberingh

Department of Medical Microbiology, School for Public Health and Primary Care (CAPHRI), Maastricht University Medical Center , Mastricht , Netherlands

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Abstract

Aim
To investigate the characteristics of meticillin-resistant S. aureus (MRSA), extended-spectrum (ESBL), and plasmid-mediated AmpC beta-lactamase producing Gram-negative bacteria causing skin and soft tissue infections (SSTIs) in hospital and outpatient settings of Zenica-Doboj Canton, Bosnia and Herzegovina.
Methods
 Antibiotic susceptibility was determined by disc-diffusion and broth microdillution methods according to CLSI guidelines. MecA gene was detected by PCR, and genetic characterization of MRSA was performed using spa-typing and the algorithm based upon repeat patterns (BURP). Double-disk-synergy test was used to screen for ESBLs. PCR was used to detect blaESBL alleles. Genetic relatedness of the strains was tested by PFGE.
Results
 Seventeen in-patients with MRSA, 13 with ESBL-producing Gram-negative bacteria and three patients co-infected with
both, were detected. Five MRSA and 16 ESBL-producing Gramnegative bacteria were found in outpatient samples. Klebsiella spp. was isolated in 11 in- and seven outpatients. MLST CC152 was the most prevalent MRSA. Seven (38.9%) Klebsiella spp. yielded amplicons with primers specific for SHV, TEM-1 and CTXM group 1 β-lactamases. Eight K. pneumonia (44.4%) and 16 (64%) MRSA (including the in- and outpatient) strains were clonally related.
Conclusion
The presence of MRSA and ESBL-producing organisms causing SSTIs in the community poses a substantial concern,
due to the high morbidity and mortality associated with possible consequent hospital infections. 

Keywords:

surgical wound infections,
CTX-M beta-lactamase,
MLST CC152,
antibiotic resistance

References

1.
Edelsberg J, Taneja C, Zervos M, Haque N, Moore C, Reyes K, et al. Trends in US hospital admissions for skin and soft tissue infections. Emerg Infect Dis. 2009;1516–8.
2.
Nubile D, Lipsky M, B. Complicated infections of the skin and skin structures: when the infection is more than skin deep. J Antimicrob Chemother. 2004;(Suppl 2):37–50.
3.
Stevens D, Bisno A, Chambers H, Everett E, Dellinger P, Goldstein E, et al. Infectious Diseases Society of America. Practice guidelines for the diagnosis and management of skin and soft-tissue infections. Clin Infect Dis. 2005;1373–406.
4.
Pallin D, Egan D, Pelletier A, Espinola J, Hooper D, Camargo C. Increased US emergency department visits for skin and soft tissue infections, and changes in antibiotic choices, during the emergence of community-associated methicillin-resistant Staphylococcus aureus. Ann Emerg Med. 2008;291–8.
5.
Moet G, Jones R, Biedenbach D, Stilwell M, Fritsche T. Latin America, and Europe: report from the SENTRY Antimicrobial Surveillance Program. Diagn Microbiol Infect Dis. 1998;7–13.
6.
Stenstrom R, Grafstein E, Romney M, Fahimi J, Harris D, Hunte G, et al. Prevalence of and risk factors for methicillin-resistant Staphylococcus aureus skin and soft tissue infection in a Canadian emergency department. CJEM. 2009;430–8.
7.
Fernandes R, Prudêncio C. Post-surgical wound infections involving Enterobacteriaceae with reduced susceptibility to β-lactams in two Portuguese hospitals. Int Wound J. 2010;508–14.
8.
Jacoby G, Munoz-Price L. The new β-lactamases. N Engl J Med. 2005;380–92.
9.
Pallecchi L, Bartoloni A, Fiorelli C, Mantella A, Maggio D, Gamboa T, et al. Rapid dissemination and diversity of CTX-M extended-spectrum β-lactamase genes in commensal Escherichia coli isolates from healthy children from low resource settings in Latina America. Antimicrob Agents Chemother. 2007;2720–5.
10.
Literacka E, Bedenić B, Baraniak A, Fiett J, Tonkić M, Jajić-Bencić I, et al. bla CTX-M genes in Escherichia coli from Croatian hospitals are located in new (bla CTX-M-3 ) and widely spread (bla CTX-M-3a , bla CTX-M-15 ) genetic structures. Antimicrob Agents Chemother. 2009;1630–5.
11.
Perez-Perez F, Hanson N. Detection of plasmidmediated AmpC β-lactamase genes in clinical isolates by using multiplex PCR. J Clin Microbiol. 2002;2153–62.
12.
Tenth Informational Supplement M. :100-S118.
13.
Wayne P, Usa. 2010;
14.
Donker G, Deurenberg R, Driessen C, Sebastian S, Nys S, Stobberingh E. The population structure of Staphylococcus aureus among general practice patients from The Netherlands. Clin Microbiol Infect. 2009;137–43.
15.
Jarlier V, Nicolas M, Fournier G, Philippon A. Extended broad-spectrum ß-lactamases conferring transferable resistance to newer beta-lactam agents in Enterobacteriaceae: hospital prevalence and susceptibility patterns. Rev Infect Dis. 1988;867–78.
16.
Elwell L, Falkow S. The characterization of R plasmids and the detection of plasmid-specified genes. Antibiotics in Laboratory Medicine. 1986;683–721.
17.
Melles D, Gorkink R, Boelens H, Snijders S, Peeters J, Moorhouse M, et al. Natural population dynamics and expansion of pathogenic clones of Staphylococcus aureus. J Clin Investig. 2004;1732–40.
18.
Strommenger B, Kettlitz C, Weniger T, Harmsen D, Friedrich A, Witte W. Assignment of Staphylococcus isolates to groups by spa typing, SmaI macrorestriction anaylisis, and multilocus sequence typing. J Clin Microbiol. 2006;2533–40.
19.
Ruppitsch W, Indra A, Stöger A, Mayer B, Stadlbauer S, Wewalka G, et al. Clasifying spa types in complexes improves interpretation of typing results for methicillin-resistant Staphylococcus aureus. J Clin Microbiol. 2006;2442–8.
20.
Aires-De-Sousa M, Boye K, De Lencastre H, Deplano A, Enright M, Friedrich E, et al. High interlaboratory reproducibility of DNA sequence-based typing of bacteria in a multicenter study. J Clin Microbiol. 2006;619–21.
21.
Nüesch-Inderbinen M, Hächler H, Kayser F. Detection of genes coding for extended-spectrum SHV β-lactamases in clinical isolates by a molecular genetic method, and comparison with the E test. Eur J Clin Microbiol Infect Dis. 1996;398–402.
22.
Arlet G, Brami G, Decre D, Flippo A, Gaillot O, Lagrange P, et al. Molecular characterization by PCR restriction fragment polymorphism of TEM β-lactamases. FEMS Microbiol Lett. 1995;203–8.
23.
Woodford N, Fagan E, Ellington M. Development of a multiplex PCR assay for genes encoding CTX-M extended-spectrum β-lactamases. Clin Microbiol Infect. 2005;121.
24.
Bush K, Jacoby G. Amino acid sequences for TEM, SHV and OXA extended-spectrum and inhibitor resistant β-lactamases. 2002;
25.
Huang YC, Chou YH, Su LH, Lien, Lin RI, T-Y. Methicillin-resistant Staphylococcus aureus colonization and its association with infection among infants hospitalized in Neonatal Intensive Care Units. Pediatrics. 2006;469–74.
26.
Kaufman M. Molecular biology. Protocols and clinical applications. 1998;33–51.
27.
Tenover F, Arbeit R, Goerling R, Mickelsen P, Murray B, Persing D, et al. Interpreting chromosomal DNA restriction patterns produced by pulsed-field gel electrophoresis; criteria for bacterial strain typing. J Clin Microbiol. 1995;2233–9.
28.
Frazee B, Lynn J, Charlebois E, Lambert L, Lowery D, Perdreau-Remington F. High prevalence of methicillin-resistant Staphylococcus aureus in emergency department skin and soft tissue infections. Ann Emerg Med. 2005;311–20.
29.
Mithoe D, Rijnders M, Roede B, Stobberingh E, Möller A. Prevalence of community-associated meticillin-resistant Staphylococcus aureus and Panton-Valentine leucocidin-positive S. aureus in general practice patients with skin and soft tissue infections in the northern and southern regions of The Netherlands. Eur J Clin Microbiol Infect Dis. 2012;349–56.
30.
Dryden M. Skin and soft tissue infection: microbiology and epidemiology. Int J Antimicrob Agents. 2009;(Suppl 3):2–7.
31.
Urth T, Juul G, Skov R, Schonheyder H. Spread of a methicillin-resistant Staphylococcus aureus ST80-IV clone in a Danish community. Infect Control Hosp Epidemiol. 2005;144–9.
32.
Sax H, Posfay-Barbe K, Harbarth S, Francois P, Touveneau S, Silva P, et al. Control of a cluster of community-associated, methicillin-resistant Staphylococcus aureus in neonatology. J Hosp Infect. 2006;93–100.
33.
Uzunović-Kamberović S, Rijnders M, Stobberingh E, Ibrahimagić A, Kamberović F, Ille T. Molecular characterization of methicillin-susceptible and methicillin-resistant Staphylococcus aureus in inpatients and outpatients in Bosnia and Herzegovina. Wien Med Wochenschr. 2013;13–20.
34.
Ibrahimagić A, Bedenić B, Kamberović F, Uzunović S. High prevalence of CTX-M-15 and first report of CTX-M-3, CTX-M-22, CTX-M-28 and plasmid-mediated AmpC beta-lactamase producing Enterobacteriaceae causing urinary tract infections in Bosnia and Herzegovina in hospital and community settings. J Infect Chemother. 2015;363–9.
35.
Fortunov R, Hulten K, Hammerman W, Eo M, Kaplan S. Community-acquired Staphylococcus aureus infections in term and near-term previously healthy neonates. Pediatrics. 2006;874–81.
36.
Pitout J, Laupland K. Extended-spectrum betalactamase-producing Enterobacteriaceae: an emerging public-health concern. Lancet Infect Dis. 2008;159–66.
37.
Mirelis B, Navarro F, Miro E, Mesa R, Coll P, Prats G. Community transmission of extended-spectrum beta-lactamase. Emerg Infect Dis. 2003;1024–5.
38.
Blaschke A, Korgenski K, Daly J, Br L, Pavia A, Byington C. Extended-spectrum β-Lactamaseproducing pathogens in a children’s hospital: a five-year experience. Am J Infect Control. 2009;435–41.
39.
Garcia C, F, Garcia S, C, De La Gandara P, M, et al. Prevalence of fecal carriage of ESBL-producing Enterobacteriaceae in hospitalized and ambulatory patients during two non-outbreak periods. Eur J Clin Microbiol Infect Dis. 2007;77–8.
40.
Stevens M, Hennessy T, Baggett H, Bruden D, Parks D, Klejka J. Methicillin-resistant Staphylococcus aureus carriage and risk factors for skin infections. Southwestern Alaska, USA Emerg Infect Dis. 2010;797–803.
41.
Al-Tawfiq, J. Father-to-infant transmission of community acquired methicillin-resistant Staphylococcus aureus in a. Neonatal Intensive Care Unit Infect Control Hosp Epidemiol. 2006;636–7.
42.
Hsiu-Nien S, Li C, L. Skin and soft tissue infections in hospitalized and critically ill patients: a nationwide population-based study. BMC Infect Dis. 2010;151.

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