Asymptomatic colonization of Staphylococcus aureus with intermediate resistance to vancomycin harboring vanB resistance gene
Objective: Vancomycin has been used worldwide due to empirical therapy against methicillin-resistant Staphylococcus aureus infections. As a result a selective pressure that favors the outgrowth of vancomycin intermediate S. aureus clones will be created. This study was carried out to evaluate vancomycin resistance pattern of S. aureus in Jordan.
Methods: A total of 1179 samples, including 566 (48%) from human and 613 (52%) from animals were examined for the presence of S. aureus using standard biochemical tests and polymerase chain reaction (PCR) amplification of coa gene. Resistance to antibiotics was determined by the disk diffusion method. Methicillin resistance strains were tested for vancomycin resistance by minimal inhibitory concentration (MIC), E- test, and the results were confirmed by amplification of van genes, and Pulsed-field gel electrophoresis (PFGE).
Results: The prevalence of S. aureus among human source was: 19.35%, 14%, and 8.8% for nasal, nail, and skin, respectively, and for animal sources 27.3%, 5.51%, and 15.86% for milk, nasal, and meat, respectively. Four VISA strains (1.87%) were found to colonize human nares, nails, and skin with vancomycin MIC of 4-8 Î¼g/ml. Van B resistance gene was detected and PFGE with SmaI-digested VISA genomic DNA revealed two different pulsotypes.
Conclusion: This is believed to be the first report of VISA strains containing vanB gene isolated from a routine carriage survey. Effective screening directed to persons colonized with VISA should therefore be a priority.
2. Klevens RM, Morrison MA, Nadle J, Petit S, Gershman K, et al. Invasive methicillin-resistant Staphylococcus aureus infections in the United States. Journal of the American Medical Association 2007; 298:1763â€“1771.
3. Nickerson EK, West TE, Day NP, and Peacock SJ. Staphylococcus aureus disease and drug resistance in resource-limited countries in south and east Asia. Lancet Infectious Diseases 2009; 9: 130â€“135.
4. KeÂ´rouanton A, Hennekinne JA, Letertre C, Petit L, Chesneau O, Brisabois A, and Buyser MLD. Characterization of Staphylococcus aureus strains associated with food poisoning outbreaks in France. Int J Food Microbiol. 2007; 115: 369â€“375.
5. Hiramatsu K, Hanaki H, Ino T, Oguri YT, and Tenover FC. Methicillin-resistant Staphylococcus aureus clinical strain with reduced susceptibility. J Antimicrob Chemother.1997; 40: 135-6.
6. Assadullah S, Kakru DK, Thoker MA, Bhat FA, Hussain N, Shah A. Emergence of low level vancomycin resistance in MRSA. Indian J Med Microbiol. 2003; 21: 196-198.
7. Francia MV, and Clewell DB. Transfer origins in the conjugative Enterococcus faecalis plasmids pAD1 and pAM373: identification of the pAD1-like nic site, a specific relaxase and a possible TraG-like protein. Mol. Microbiol. 2002; 45:375â€“395.
8. Hiramatsu K. The emergence of Staphylococcus aureus with reduced susceptibility to vancomycin in Japan. Am J Med. 1998; 104(5A): 7Sâ€“10S
9. Liu C, Chambers HF. Staphylococcus aureus with heterogeneous resistance to vancomycin: epidemiology, clinical significance, and critical assessment of diagnostic methods. Antimicrob Agents Chemother. 2003; 47: 3040â€“3045.
10. Tenover FC, Biddle JW, Lancaster MV. Increasing resistance to vancomycin and other glycopeptides in Staphylococcus aureus. Emerg Infect Dis. 2001; 7: 327â€“332
11. Holmes NE, Johnson PD, Howden BP. Relationship between vancomycin-resistant Staphylococcus aureus, vancomycin-intermediate S. aureus, high vancomycin MIC, and outcome in serious S. aureus infections. J Clin Microbiol. 2012; 50(8): 2548â€“2552.
12. Bakri FG, Abu AL-Hommos N, Shehabi A, Naffa RG, Cui L, et al. Persistent bacteraemia due to methicillin-resistant Staphylococcus aureus with reduced susceptibility to vancomycin in a patient with erythrodermic psoriasis. Scandinavian Journal of Infectious Diseases. 2007; 39(5): 457-460
13. Balkhair A, Al-Muharrmi Z, Darwish L, Sallam M. Treatment of vancomycin-intermediate Staphylococcus aureus (VISA) endocarditis with linezolid. International journal of infectious diseases. 2009; 14 Suppl 3:e227-9 â€¢
14. El Ayoubi MD, Hamze M, Mallata H, Achkar M, Dabboussi F. Glycopeptide intermediate Staphylococcus aureus and prevalence of the luk-PV gene in clinical isolates, in Northern Lebanon. Med Mal Infect. 2014; 44(5):223-228.
15. Cheryl A, Mather I, Brian JW, Shobini S, Dhruba JS, Susan MB. Rapid Detection of Vancomycin Intermediate Staphylococcus aureus (VISA) by Matrix Assisted Laser Desorption Ionization Time-of-Flight Mass Spectrometry (MALDI-TOF MS). J Clin Microbiol. 2016; doi:10.1128/JCM.02428-15
16. Woodford N. Epidemiology of the genetic elements responsible for acquired glycopeptide resistance in enterococci. Microb Drug Resist. 2001; 7:229-36.
17. Banerjee T, and Anupurba S. Colonization with Vancomycin-Intermediate Staphylococcus aureus Strains Containing the vanA Resistance Gene in a Tertiary-Care Center in North India. J Clin Microbiol.2012; 50(5): 1730â€“1732.
18. De-Jonge R, Verdier JE, and Havelaar AH. Prevalence of meticillin-resistant Staphylococcus aureus amongst professional meat handlers in the Netherlands, Marchâ€“July Euro. Surveill. 2010; 18:15(46). pii: 19712
19.Tuupo PM. Acrylic Nail and Native Nail Bacteria. Saint Martinâ€™s University Biology Journal 2006; 1:57-64.
20. Arslan S, and Ã–zkardes F. Slime production and antibiotic susceptibility in Staphylococci isolated from clinical samples. MemÃ³rias do Instituto Oswaldo Cruz, Rio de Janeiro 2007; 102: 29-33.
21. Moon JS, Lee AR, Jaw SH, Kang HM, Joo YS, Park YH, Kim MN, and Koo HC. Comparison of Antibiogram, Staphylococcal Enterotoxin Productivity, and Coagulase Genotypes among Staphylococcus aureus Isolated from Animal and Vegetable Sources in Korea. Journal of Food Protection 2007; 70: 2541â€“2548.
22. Adwan G, Abusafieh D, Aref R, et al. Prevalence of microorganisms associated with intramammary infection in cows and small ruminants in the North of Palestine. J Islamic Univ Gaza. 2005; 13: 165-173.
23. Roberson JR, Fox LK, Hancock DD, Besser TE. Evaluation of methods for differentiation of coagulase-positive Staphylococci. Journal of Clinical Microbiology 1992; 30: 3217-3219.
24. Hasan AA, Hassawi DS, Al-Daghistani HI, Hawari AD. Molecular and Biochemical Identification of Coagulase Positive Staphylococcus Species Isolated from Human and Animal Sources in Jordan. International Journal of Medicine and Medical Sciences 2014; 47(1): 1491-1507
25. Rallapalli S, Verghese S, Verma RS. Validation of multiplex PCR strategy forsimultaneous detection and identification of methicillin resistant Staphylococcus aureus. Indian Journal of Medical Microbiology 2008; 26(4): 361-364.
26. Aarestrup FM, Dangler CA, Sordillo LM. Prevalence of coagulase gene polymorphism in Staphylococcus aureus isolates causing bovine mastitis. Can J Vet Res. 1995; 59: 124â€“128
27. CLSI Releases Guidelines for Defining, Establishing, and Verifying Reference Intervals in the Clinical Laboratory. December 08, 2009 10:16 ET
28. Walsh TR, Bolmstrom A, Qwarnstrom A, Ho P, Wooton M, Howe RA, MacGrowan AP, and Diekema D. Evaluation of current methods for detection of staphylococci with reduced susceptibility to glycopeptides. Journal of Clinical of Microbiology 2001; 39: 2439 â€“ 44.
29. Ke D, MeÂ´nard C, Picard FJ, Boissinot M, Ouellette M, Roy PH, and Bergeron MG. Development of conventional and real-time PCR assays for the rapid detection of group B Streptococci. Clinical Chemistry. 2000; 46: 324â€“331.
30. Yoshida T, Kondo N, Hanifah YA, Hiramatsu K. Combined use of ribotyping, PFGE typing and IS431 typing in the discrimination of nosocomial strains of methicillin-resistant Staphylococcus aureus. Microbiol Immunol. 1997; 41: 687â€“95. 20.
31. Tenover FC, Arbeit RD, Goering RV, Mickelsen PA, Murray BE, Persing DH. et al. Interpreting chromosomal DNA restriction patterns produced by pulsed-field gel electrophoresis: criteria for bacterial strain typing. J Clin Microbiol. 1995; 33: 2233â€“2239
32. Tong SYC, Davis JS, Eichenberger E, Holland TL, and Fowler JrVG. Staphylococcus aureus Infections: Epidemiology, Pathophysiology, Clinical Manifestations, and Management. Clin Microbiol Rev. 2016; 29(4): 603-661
33. Daghistani HI, Issa AA, Shehabi AA. Frequency of nasal and wound isolates of Staphylococcusaureus associated with TSST-1 production in Jordanian population. Immunology and Medical Microbiology. 2000; 27: 95-98.
34. Walther B, Hermes J, Cuny C, Wieler LH, Vincze S, Elnaga YA, Stamm I, Kopp PA, Kohn B, Witte W, Jansen A, Conraths FJ, Semmler T, Tim ET, Lubke BA. Sharing More than Friendship- Nasal Colonization with Coagulase-Positive Staphylococci (CPS) and Co-Habitation Aspects of Dogs and Their Owners. PLoS ONE 2012; 7(4): e35197.
35. Al-Zahrani SHM. Detection of antibiotic resistant Staphylococcus aureus among male carriers in Jeddah Sites. Nature and Science 2012; 10: 1-7.
36. Goja AM, Ahmed TAA, Saeed S.AM, Dirar HA. Isolation and Identification of Staphylococcus spp. in Fresh Beef. Pakistan Journal of Nutrition. 2013; 12 : 114-120.
37. Vasudevan P, Nair MK, Annamalai T, Venkitanarayanan KS. Phenotypic and genotypic characterization of bovine mastitis isolates of Staphylococcus aureus for biofilm formation. Veterinary Microbiology 2003; 92:179-85.
38. Centers for Disease Control and Prevention, Office of Infectious Disease Antibiotic resistance threats in the United States, 2013.
39. Swenson JM, Anderson KF, Lonsway DR, Thompson A, McAllister SK, Limbago BM, Carey RB, Tenover FC, Patel JB. Accuracy of commercial and reference susceptibility testing methods for detecting vancomycin-intermediate Staphylococcus aureus. J Clin Microbiol. 2009; 47: 2013â€“2017
40. Appelbaum PC. Microbiology of Antibiotic Resistance in Staphylococcus aureus. Clin Infect Dis. 2007; 45(Suppl. 3): S165-S170.
41. Ray AJ, Pultz NJ, Bhalla A, Aron DC, Donskey CJ. Coexistence of vancomycin-resistant enterococci and Staphylococcus aureus in the intestinal tracts of hospitalized patients. Clin Infect Dis. 2003; 37:875â€“881
42. Howden BP, Davies JK, Johnson PD, Stinear TP, Grayson ML. Reduced vancomycin susceptibility in Staphylococcus aureus, including vancomycin-intermediate and heterogeneous vancomycin-intermediate strains: resistance mechanisms, laboratory detection, and clinical implications. Clin Microbiol Rev. 2010; 23: 99â€“139
43. Gardete S, and Tomasz A. Mechanisms of vancomycin resistance in Staphylococcus aureus. J Clin Invest. 2014; 1: 124(7): 2836â€“2840.
44. Ogbolu DO, Alli OAT, Bello LA, and Ibrahim AO. Emergence of vancomycin intermediate Staphylococcus aureus (VISA) in clinical isolates of methicillin resistant S. aureus from south western region of Nigeria. International journal of tropical disease & health. 2015; 109(4): 1-5.
45. Khan S, Mahmud S. In vivo transfer of vancomycin resistance gene (vanA) in Staphylococcus aureus. MBAIJ. 2016; 1(1): 1- 4.
46. Courvalin P. Vancomycin Resistance in Gram-Positive Cocci. Clin Infect Dis. 2006; 42(Supplement 1): S25-S34.
47. Fridkin SK, Hageman J, McDougal LK, Mohammed J, Jarvis WR, Perl TM, et al. Epidemiological and microbiological characterization of infections caused by Staphylococcus aureus with reduced susceptibility to vancomycin, United States, 1997â€“2001. Clin Infect Dis. 2003; 36: 429â€“439.
48. Boden-Wastfelt MK, Flock JI. Incidence of the highly conserved fib gene and expression of the fibrinogen-binding (fib) protein among clinical isolates of Staphylococcus aureus. J Clin Microbiol.1995; 33:2347â€“2352..
The publication is licensed under CC By and is open access. Copyright is with author and allowed to retain publishing rights without restrictions.