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Microorganisms
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Multi-Drug Resistant (MDR) Gram-Positive Bacterial Infections
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Multi-Drug Resistant (MDR) Gram-Positive Bacterial Infections

A special issue of Microorganisms (ISSN 2076-2607). This special issue belongs to the section "Antimicrobial Agents and Resistance".

Deadline for manuscript submissions: closed (15 December 2022) | Viewed by 30798

Special Issue Editor

Dr. Giammarco Raponi

E-Mail Website
Guest Editor
Department of “Sanità Pubblica e Malattie Infettive”, Sapienza University of Rome, Rome, Italy
Interests: antimicrobial resistance; gram positive bacteria; gram negative bacteria; fungal infections; bacterial biofilms

Special Issue Information

Dear Colleagues,

Healthcare-related infections are constantly increasing due to the worldwide spread of multidrug-resistant germs, the increasing number of immunocompromised patients, the increased complexity of care, and inadequacy in the management of antibiotic therapy in terms of both dosage and duration. Gram-positive bacterial infections, often sustained by multi-resistant microorganisms, are widely spread, especially in nosocomial settings, and are frequently difficult to diagnose and treat. In 2017, the World Health Organization (WHO) published a list of bacteria for which new antibiotics are urgently needed, including priority list 2 (high priority) microorganisms such as vancomycin-resistant Enterococcus faecium and methicillin-resistant, vancomycin-intermediate/resistant Staphylococcus aureus.

The aim of this Special Issue is to focus on the etiologies, especially those that have been newly identified, as well on the diagnostic and therapeutic approaches to the worldwide emergence of MDR Gram-positive bacterial infections—an ancient yet renewed threat to human health.

Dr. Giammarco Raponi
Guest Editor

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Keywords

  • multidrug-resistant bacteria
  • Gram-positive bacteria
  • Staphylococcus aureus
  • coagulase-negative staphylococci
  • enterococci
  • Enterococcus faecium
  • Clostridioides
  • Corynebacterium
  • vancomycin
  • methicillin

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Published Papers (6 papers)

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Research

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18 pages, 2033 KiB  
Article
Molecular and Source-Specific Profiling of Hospital Staphylococcus aureus Reveal Dominance of Skin Infection and Age-Specific Selections in Pediatrics and Geriatrics
by Kamaleldin B. Said, Naif Saad Alghasab, Mohammed S. M. Alharbi, Ahmed Alsolami, Mohd Saleem, Sulaf A. Alhallabi, Shahad F. Alafnan, Azharuddin Sajid Syed Khaja, Taha E. Taha and on behalf of the Ha’il COM Research Unit Group
Microorganisms 2023, 11(1), 149; https://doi.org/10.3390/microorganisms11010149 - 6 Jan 2023
Cited by 1 | Viewed by 2752
Abstract
Staphylococcus aureus is a major human-associated pathogen that causes a wide range of clinical infections. However, the increased human dynamics and the changing epidemiology of the species have made it imperative to understand the population structure of local ecotypes, their transmission dynamics, and [...] Read more.
Staphylococcus aureus is a major human-associated pathogen that causes a wide range of clinical infections. However, the increased human dynamics and the changing epidemiology of the species have made it imperative to understand the population structure of local ecotypes, their transmission dynamics, and the emergence of new strains. Since the previous methicillin-resistant S. aureus (MRSA) pandemic, there has been a steady increase in global healthcare-associated infections involving cutaneous and soft tissue and resulting in high morbidities and mortalities. Limited data and paucity of high-quality evidence exist for many key clinical questions about the pattern of S. aureus infections. Using clinical, molecular, and epidemiological characterizations of isolates, hospital data on age and infection sites, as well as antibiograms, we have investigated profiles of circulating S. aureus types and infection patterns. We showed that age-specific profiling in both intensive care unit (ICU) and non-ICU revealed highest infection rates (94.7%) in senior-patients > 50 years; most of which were MRSA (81.99%). However, specific distributions of geriatric MRSA and MSSA rates were 46.5% and 4.6% in ICU and 35.48% and 8.065% in non-ICU, respectively. Intriguingly, the age groups 0–20 years showed uniquely similar MRSA patterns in ICU and non-ICU patients (13.9% and 9.7%, respectively) and MSSA in ICU (11.6%). The similar frequencies of both lineages in youth at both settings is consistent with their increased socializations and gathering strongly implying carriage and potential evolutionary replacement of MSSA by MRSA. However, in age groups 20–50 years, MRSA was two-fold higher in non-ICU (35%) than ICU (18.6%). Interestingly, a highly significant association was found between infection-site and age-groups (p-value 0.000). Skin infections remained higher in all ages; pediatrics 32.14%, adults 56%, and seniors 25% while respiratory infections were lower in pediatrics (14.3%) and adults (17%) while it was highest in seniors (38%). Blood and “other” sites in pediatrics were recorded (28.6%; 25%, respectively), and were slightly lower in adults (18.6%; 8.6%) and seniors (14%; 22.8%), respectively. Furthermore, a significant association existed between infection-site and MRSA (Chi-Square Test, p-value 0.002). Thus, the common cutaneous infections across all age-groups imply that skin is a significant reservoir for endogenous infections; particularly, for geriatrics MRSA. These findings have important clinical implications and in understanding S. aureus profiles and transmission dynamics across different age groups that is necessary for strategic planning in patient management and infection control. Full article
(This article belongs to the Special Issue Multi-Drug Resistant (MDR) Gram-Positive Bacterial Infections)
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15 pages, 1240 KiB  
Article
Colonization of Dogs and Their Owners with Staphylococcus aureus and Staphylococcus pseudintermedius in Households, Veterinary Practices, and Healthcare Facilities
by Christiane Cuny, Franziska Layer-Nicolaou, Robert Weber, Robin Köck and Wolfgang Witte
Microorganisms 2022, 10(4), 677; https://doi.org/10.3390/microorganisms10040677 - 22 Mar 2022
Cited by 24 | Viewed by 4119
Abstract
There are uncertainties with respect to the transmission of methicillin-susceptible and methicillin-resistant Staphylococcus aureus (MSSA and MRSA) and Staphylococcus pseudintermedius between dogs and humans. In this study, we investigated concomitant nasal colonization of dogs and humans in three cohorts. Cohort I, households owning [...] Read more.
There are uncertainties with respect to the transmission of methicillin-susceptible and methicillin-resistant Staphylococcus aureus (MSSA and MRSA) and Staphylococcus pseudintermedius between dogs and humans. In this study, we investigated concomitant nasal colonization of dogs and humans in three cohorts. Cohort I, households owning dogs: In 42 of 84 households, 66 humans (36.9%) and 10 dogs (8.9%) carried S. aureus. MRSA, attributed to sequence type (ST) 22 and ST130, were detected in two (1.1%) of the humans but in none of the dogs. Typing by means of spa-typing and whole-genome sequencing (WGS) indicated eight transmissions of S. aureus between humans and dogs in 8 of 42 (19.0%) households with human S. aureus carriers, whereas in 11 of 38 (29.0%) households with ≥two persons and S. aureus colonization of humans, 15 human-to-human transmissions were observed (p = 0.43). S. pseudintermedius was isolated from 42 dogs (37.5%), but from only one human (0.6%). In this case, WGS-based typing indicated strong relatedness of this isolate with a canine isolate from the same household. Cohort II, dogs and their owners visiting a veterinary practice: Among 17 humans and 17 dogs attending a veterinary practice, MSSA was detected in three humans and two dogs, and S. pseudintermedius in only six dogs. Cohort III, dogs used for animal-assisted interventions in human healthcare facilities and their owners: MSSA was obtained in 1 of 59 dogs (1.7%) and in 17 of 60 (28.3%) of the dog owners, while S. pseudintermedius was isolated from seven (12%) dogs and one (1.7%) human owner. We conclude that the risk of exchanging S. aureus/MRSA between humans and dogs is higher than that for S. pseudintermedius. Full article
(This article belongs to the Special Issue Multi-Drug Resistant (MDR) Gram-Positive Bacterial Infections)
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15 pages, 4059 KiB  
Article
Intracellular Survival of Biofilm-Forming MRSA OJ-1 by Escaping from the Lysosome and Autophagosome in J774A Cells Cultured in Overdosed Vancomycin
by Shiro Jimi, Michinobu Yoshimura, Kota Mashima, Yutaka Ueda, Motoyasu Miyazaki and Arman Saparov
Microorganisms 2022, 10(2), 348; https://doi.org/10.3390/microorganisms10020348 - 2 Feb 2022
Viewed by 1823
Abstract
We investigated the drug-resistant mechanisms of intracellular survival of methicillin-resistant S. aureus (MRSA). Our established MRSA clinical strain, OJ-1, with high biofilm-forming ability, and a macrophage cell line, J774A, were used. After ingestion of OJ-1 by J774A, the cells were incubated for ten [...] Read more.
We investigated the drug-resistant mechanisms of intracellular survival of methicillin-resistant S. aureus (MRSA). Our established MRSA clinical strain, OJ-1, with high biofilm-forming ability, and a macrophage cell line, J774A, were used. After ingestion of OJ-1 by J774A, the cells were incubated for ten days with vancomycin at doses 30 times higher than the minimum inhibitory concentration. The number of phagocytosed intracellular OJ-1 gradually decreased during the study but plateaued after day 7. In J774A cells with intracellular OJ-1, the expression of LysoTracker-positive lysosomes increased until day 5 and then declined from day 7. In contrast, LysoTracker-negative and OJ-1-retaining J774A cells became prominent from day 7, and intracellular OJ-1 also escaped from the autophagosome. Electron microscopy also demonstrated that OJ-1 escaped the phagosomes and was localized in the J774A cytoplasm. At the end of incubation, when vancomycin was withdrawn, OJ-1 started to grow vigorously. The present results indicate that intracellular phagocytosed biofilm-forming MRSA could survive for more than ten days by escaping the lysosomes and autophagosomes in macrophages. Intracellular MRSA may survive in macrophages, and accordingly, they could be resistant to antimicrobial drug treatments. However, the mechanisms their escape from the lysosomes are still unknown. Additional studies will be performed to clarify the lysosome-escaping mechanisms of biofilm-forming MRSA. Full article
(This article belongs to the Special Issue Multi-Drug Resistant (MDR) Gram-Positive Bacterial Infections)
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Review

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12 pages, 296 KiB  
Review
Multidrug-Resistant Enterococcal Infection in Surgical Patients, What Surgeons Need to Know
by Soroush Farsi, Ibrahim Salama, Edgar Escalante-Alderete and Jorge Cervantes
Microorganisms 2023, 11(2), 238; https://doi.org/10.3390/microorganisms11020238 - 17 Jan 2023
Cited by 11 | Viewed by 2709
Abstract
Enterococci are organisms that can be found in the normal intestinal and skin microbiota and show remarkable ability to acquire antibiotic resistance. This is an enormous challenge for surgeons when faced with surgical site infections caused by multidrug-resistant (MDR) Enterococci. Due to an [...] Read more.
Enterococci are organisms that can be found in the normal intestinal and skin microbiota and show remarkable ability to acquire antibiotic resistance. This is an enormous challenge for surgeons when faced with surgical site infections caused by multidrug-resistant (MDR) Enterococci. Due to an increase in the prevalence of MDR Enterococcus within the last few decades, there has been a major decrease in therapeutic options, because the majority of E. faecium isolates are now resistant to ampicillin and vancomycin and exhibit high-level resistance to aminoglycosides, traditionally three of the most useful anti-enterococcal antibiotics. There is limited data regarding the magnitude and pattern of multidrug resistance among the enterococcal genus causing surgical site infections in hospitalized patients. The scope of the review is to summarize the most recent findings in the emergence of postoperative MDR Enterococci and discuss recent mechanisms of resistance and the best treatment options available. Full article
(This article belongs to the Special Issue Multi-Drug Resistant (MDR) Gram-Positive Bacterial Infections)
51 pages, 2032 KiB  
Review
Vancomycin Resistance in Enterococcus and Staphylococcus aureus
by Gen Li, Mark J. Walker and David M. P. De Oliveira
Microorganisms 2023, 11(1), 24; https://doi.org/10.3390/microorganisms11010024 - 21 Dec 2022
Cited by 35 | Viewed by 13302
Abstract
Enterococcus faecalis, Enterococcus faecium and Staphylococcus aureus are both common commensals and major opportunistic human pathogens. In recent decades, these bacteria have acquired broad resistance to several major classes of antibiotics, including commonly employed glycopeptides. Exemplified by resistance to vancomycin, glycopeptide resistance [...] Read more.
Enterococcus faecalis, Enterococcus faecium and Staphylococcus aureus are both common commensals and major opportunistic human pathogens. In recent decades, these bacteria have acquired broad resistance to several major classes of antibiotics, including commonly employed glycopeptides. Exemplified by resistance to vancomycin, glycopeptide resistance is mediated through intrinsic gene mutations, and/or transferrable van resistance gene cassette-carrying mobile genetic elements. Here, this review will discuss the epidemiology of vancomycin-resistant Enterococcus and S. aureus in healthcare, community, and agricultural settings, explore vancomycin resistance in the context of van and non-van mediated resistance development and provide insights into alternative therapeutic approaches aimed at treating drug-resistant Enterococcus and S. aureus infections. Full article
(This article belongs to the Special Issue Multi-Drug Resistant (MDR) Gram-Positive Bacterial Infections)
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Other

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11 pages, 531 KiB  
Case Report
Nocardia Infections in the Immunocompromised Host: A Case Series and Literature Review
by Emanuele Palomba, Arianna Liparoti, Anna Tonizzo, Valeria Castelli, Laura Alagna, Giorgio Bozzi, Riccardo Ungaro, Antonio Muscatello, Andrea Gori and Alessandra Bandera
Microorganisms 2022, 10(6), 1120; https://doi.org/10.3390/microorganisms10061120 - 29 May 2022
Cited by 8 | Viewed by 2965
Abstract
Nocardia is primarily considered an opportunistic pathogen and affects patients with impaired immune systems, solid-organ transplant recipients (SOTRs), and patients with haematologic malignancies. We present the cases of six patients diagnosed with nocardiosis at our center in the last two years, describing the [...] Read more.
Nocardia is primarily considered an opportunistic pathogen and affects patients with impaired immune systems, solid-organ transplant recipients (SOTRs), and patients with haematologic malignancies. We present the cases of six patients diagnosed with nocardiosis at our center in the last two years, describing the various predisposing conditions alongside the clinical manifestation, the diagnostic workup, and the treatment course. Moreover, we propose a brief literature review on Nocardia infections in the immunocompromised host, focusing on SOTRs and haematopoietic stem cell transplantation recipients and highlighting risk factors, clinical presentations, the diagnostic tools available, and current treatment and prophylaxis guidelines. Full article
(This article belongs to the Special Issue Multi-Drug Resistant (MDR) Gram-Positive Bacterial Infections)
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