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Background : Patients hospitalized with Staphylococcus aureus bacteraemia have an unacceptably high mortality rate. Literature available to date has shown that timely selection of the most appropriate antibacterial may reduce mortality. One tool that may help with this selection is a polymerase chain reaction (PCR) assay that distinguishes methicillin (meticillin)-resistant S. aureus (MRSA) from methicillin-susceptible S. aureus (MSSA) in less than 1 hour. To date, no information is available evaluating the impact of this PCR technique on clinical or economic outcomes. Objective : To evaluate the effect of a rapid PCR assay on mortality and economics compared with traditional empiric therapy, using a literaturederived model. Methods : A literature search for peer-reviewed European (EU) and US publications regarding treatment regimens, outcomes and costs was conducted. Information detailing the rates of infection, as well as the specificity and sensitivity of a rapid PCR assay (Xpert MRSA/SA Blood Culture PCR®) were obtained from the peer-reviewed literature. Sensitivity analysis varied the prevalence rate of MRSA from 5% to 80%, while threshold analysis was applied to the cost of the PCR test. Hospital and testing resource consumption were valued with direct medical costs, adjusted to year 2009 values. Adjusted life-years were determined using US and WHO life tables. The cost-effectiveness ratio was defined as the cost per life-year saved. Incremental cost-effectiveness ratios (ICERs) were calculated to determine the additional cost necessary to produce additional effectiveness. All analyses were performed using TreeAge Software (2008). Results : The mean mortality rates were 23% for patients receiving empiric vancomycin subsequently switched to semi-synthetic penicillin (SSP) for MSSA, 36% for patients receiving empiric vancomycin treatment for MRSA, 59% for patients receiving empiric SSP subsequently switched to vancomycin for MRSA and 12% for patients receiving empiric SSP for MSSA. Furthermore, with an MRSA prevalence of 30%, the numbers of patients needed to test in order to save one life were 14 and 16 compared with empiric vancomycin and SSP, respectively. The absolute mortality difference for MRSA prevalence rates of 80% and 5% favoured the PCR testing group at 2% and 10%, respectively, compared with empiric vancomycin and 18% and 1%, respectively, compared with empiric SSP. In the EU, the cost-effectiveness ratios for empiric vancomycin- and SSP-treated patients were h695 and h687 per life-year saved, respectively, compared with h636 per life-year saved for rapid PCR testing. In the US, the cost-effectiveness ratio was $US898 per life-year saved for empiric vancomycin and $US820 per life-year saved for rapid PCR testing. ICERs demonstrated dominance of the PCR test in all instances. Threshold analysis revealed that PCR testing would be less costly overall, even at greatly inflated assay prices. Conclusion : Rapid PCR testing for MRSA appears to have the potential to reduce mortality rates while being less costly than empiric therapy in the EU and US, across a wide range of MRSA prevalence rates and PCR test costs.

This study aimed to comprehensively investigate the antibiotic resistance characteristics of in chronic rhinosinusitis (CRS) patients and to identify key determinants influencing the development of methicillin-resistant Staphylococcus aureus (MRSA) infections. A retrospective analysis was conducted on 180 CRS patients admitted to our hospital between February 2022 and July 2024. Nasal secretion samples were collected upon admission for strain isolation, and antibiotic susceptibility testing was performed using an automated microbiology system. Patients were categorized into MRSA and methicillin-sensitive Staphylococcus aureus (MSSA) groups based on oxacillin resistance. Univariate analysis was used to screen potential risk factors, followed by multivariate logistic regression to determine independent predictors. Among 180 isolated strains, 74 (41.1%) were MRSA and 106 (58.9%) were MSSA. MRSA strains exhibited significantly higher resistance rates to cefoxitin, amikacin, ciprofloxacin, and six other antibiotic classes compared to MSSA strains (all P<0.05), with resistance exceeding 50% for fluoroquinolones and macrolides. Univariate analysis identified 12 clinical factors associated with MRSA infection, including male sex, smoking history, disease duration >5 years, and frequent antibiotic use. Multivariate regression analysis confirmed nine independent risk factors: male sex (OR=2.31), nasal structural abnormalities (OR=1.89), previous nasal surgery (OR=1.76), ≥3 acute infections per year (OR=2.14), excessive antibiotic exposure, and others. MRSA exhibits pronounced resistance to commonly used antibiotics in CRS treatment. Clinicians should prioritize targeted screening for high-risk patients, optimize antibiotic stewardship, and enhance postoperative nasal function management. Implementing a multifaceted approach-including early risk assessment, standardized antibiotic use, and intensified follow-up care-can effectively mitigate MRSA infection risks and improve overall treatment outcomes for CRS patients.

Diabetic foot ulcers are often complicated by infection. Among pathogens, Staphylococcus aureus predominates. The prevalence of methicillin-resistant S. aureus (MRSA) in infected foot ulcers is 15–30% and there is an alarming trend for increase in many countries. There are also data that recognize new strains of MRSA that are resistant to vancomycin. The risk for MRSA isolation increases in the presence of osteomyelitis, nasal carriage of MRSA, prior use of antibacterials or hospitalization, larger ulcer size and longer duration of the ulcer. The need for amputation and surgical debridement increases in patients infected with MRSA. Infections of mild or moderate severity caused by community-acquired MRSA can be treated with cotrimoxazole (trimethoprim/sulfamethoxazole), doxycycline or clindamycin when susceptibility results are available, while severe community-acquired or hospital-acquired MRSA infections should be managed with glycopeptides, linezolide or daptomycin. Dalbavancin, tigecycline and ceftobiprole are newer promising antimicrobial agents active against MRSA that may also have a role in the treatment of foot infections if more data on their efficacy and safety become available.

Background: Infective endocarditis continues to represent a challenge for healthcare systems, requiring careful management and resources. Recent studies have indicated a shift in the predominant pathogens of concern, with Streptococcus sp. a being superseded by Staphylococcus sp. and Enterococcus sp. as the leading causes of concern. This shift is of concern as it is associated with Staphylococcus Aureus which has a high virulence rate and a tendency to form a biofilm, meaning that non-surgical therapy may not be effective. It is imperative to deliberate on the likelihood of platelet blood clot formation, which may be accompanied by bacterial infestation and the development of a biofilm. Methods: MEDLINE, Embase, and Pubmed were searched using terms relating to ‘endocarditis’ and ‘Staphilococcus aureus’, along with ‘epidemiology’, ‘pathogenesis’, ‘coagulation’, ‘platelet’, ‘aggregation’, and ‘immunity’. The search focused on publications from the past 15 years, but excluded older, highly regarded articles. We also searched the reference lists of relevant articles. Recommended review articles are cited for more details. Results: An endocarditis lesion is believed to be a blood clot infected with bacteria that adheres to the heart valves. Infective endocarditis is a good example of immunothrombosis, where the coagulation system, innate immunity and the function of coagulation in isolating and eliminating pathogens interact. However, in the context of infective endocarditis, immunothrombosis unintentionally establishes an environment conducive to bacterial proliferation. The process of immunothrombosis impedes the immune system, enabling bacterial proliferation. The coagulation system plays a pivotal role in the progression of this condition. Conclusion: The coagulation system is key to how bacteria attach to the heart valves, how vegetations develop, and how complications like embolisation and valve dysfunction occur. Staphylococcus aureus, the main cause of infective endocarditis, can change blood clotting, growing well in the fibrin-rich environment of vegetation. The coagulation system is a good target for treating infective endocarditis because of its central role in the disease. But we must be careful, as using blood-thinning medicines in patients with endocarditis can often lead to an increased risk of bleeding.

Background Prolonged hemodiafiltration (HDF) is a blood purification therapy used for fulminant hepatitis to improve impaired consciousness, hemodynamics, hyperammonemia, and renal function. Methicillin-resistant  Staphylococcus aureus  (MRSA) infections, including sepsis and fulminant hepatitis, are routinely treated with antibiotics. However, no studies have investigated the effects of prolonged HDF on the pharmacokinetics of the anti-MRSA antibiotics teicoplanin and vancomycin. We performed an exploratory assessment of optimal dosing of these drugs in critically ill patients undergoing prolonged HDF. Methods In this single-center retrospective study, we enrolled patients who underwent therapeutic drug monitoring after the administration of a maintenance dose of teicoplanin or vancomycin during prolonged HDF. Patients treated with teicoplanin were categorized into albumin (ALB) administration, plasma exchange (PE), and normal administration groups. The pharmacokinetics of vancomycin were relatively unaffected by serum ALB levels; therefore, patients treated with vancomycin were categorized into PE and normal administration groups. Dialysis prescription parameters were recorded for each patient. These parameters are summarized alongside the maintenance doses and trough concentrations of anti-MRSA antibiotics in a table 7 . Results During prolonged HDF, the dialysis flow rate was 30,000 mL/h (interquartile range [IQR], 30,000–30,000), and the hemofiltration ratio was 2000 mL/h (IQR 2000–2500). In the normal administration group, the median maintenance dose of teicoplanin was 10.4 mg/kg/day (IQR 6.5–13.3), and the trough concentration was 17.4 μg/mL (IQR 15.9–17.8). In the ALB and PE groups, the median maintenance of teicoplanin dose was 9.4 mg/kg/day (IQR 7.8–9.9), and the trough concentration was 9.2 μg/mL (IQR 8.1–10.9). The median maintenance dose of vancomycin in the normal administration group was 40.7 mg/kg/day (IQR 25.4–45.7), and the trough concentration was 10.2 μg/mL (IQR 9.5–10.4). In the PE group, the maintenance dose of vancomycin was 23.0 mg/kg/day, and the trough concentration was 4.43 μg/mL. Conclusions The findings of this study suggest that when administering teicoplanin and vancomycin to patients undergoing prolonged HDF, their maintenance dosages may need to be adjusted not only according to dialysis prescription parameters, but also in consideration of the patient’s general condition and concomitant therapies such as plasma exchange or albumin administration.

Dr. Karen Kotloff, a pediatric infectious disease specialist, at the University of Maryland School of Medicine, talks about her research into staph aureus infections in infants and neonatal intensive care units.

Background Diabetic foot ulcer is the most costly and complex challenge for patients with diabetes. We hereby assessed the effectiveness of different preconditioned adipose-derived mesenchymal stem cells (AD-MSCs) and photobiomodulation protocols on treating an infected ischemic wound in type 1 diabetic rats. Methods There were five groups of rats: (1) control, (2) control AD-MSCs [diabetic AD-MSCs were transplanted (grafted) into the wound bed], (3) AD-MSC + photobiomodulation in vivo (diabetic AD-MSCs were grafted into the wound, followed by in vivo PBM treatment), (4) AD-MSCs + photobiomodulation in vitro, and (5) AD-MSCs + photobiomodulation in vitro + in vivo. Results Diabetic AD-MSCs preconditioned with photobiomodulation had significantly risen cell function compared to diabetic AD-MSC. Groups 3 and 5 had significantly decreased microbial flora correlated to groups 1 and 2 (all, p  = 0.000). Groups 2, 3, 4, and 5 had significantly improved wound closure rate (0.4, 0.4, 0.4, and 0.8, respectively) compared to group 1 (0.2). Groups 2–5 had significantly increased wound strength compared to group 1 (all p  = 0.000). In most cases, group 5 had significantly better results than groups 2, 3, and 4. Conclusions Preconditioning diabetic AD-MSCs with photobiomodulation in vitro plus photobiomodulation in vivo significantly hastened healing in the diabetic rat model of an ischemic infected delayed healing wound.

The interaction between Lactobacillus plantarum and Staphylococcus aureus strains FRI-1169 and MN8, two original isolated strains from menstrual toxic shock syndrome (mTSS) cases, is a key focus for developing non-antibiotic strategies to control S. aureus-related infections. While the antagonistic effects of Lactobacilli species on S. aureus through mechanisms like organic acid and bacteriocin production are known, the molecular dynamics of these interactions remain underexplored. This study employs a proteomic approach to analyze the interactions between L. plantarum WCFS1 and S. aureus strains, FRI-1169 and MN8, during co-culture. We profiled differentially expressed proteins (DEPs) found in the spent media and cytosols of both bacteria, revealing distinct directional and strain-specific responses. The findings demonstrate that L. plantarum exerts a more pronounced effect on S. aureus, with more DEPs and upregulated proteins, while S. aureus showed fewer DEPs and more downregulated proteins. These strain-specific interactions highlight the complex metabolic and regulatory adjustments between these bacterial species. This research provides valuable insights into the molecular mechanisms of Lactobacillus-S. aureus antagonism and underscores the potential of proteomic analysis as a powerful tool for studying bacterial dynamics in co-culture systems.

Background The presence of Staphylococcus aureus in the bloodstream can lead to the development of sepsis; however, the severity and risk factors of the systemic inflammatory response to Staphylococcus aureus bloodstream infections were unclear. This study is aimed to build a model to predict the risk of sepsis in children with Staphylococcus aureus bloodstream infections. Methods A retrospective analysis of hospitalized pediatric patients diagnosed with Staphylococcus aureus bloodstream infections was performed between January 2013 and December 2019. Each patient was assessed using the pediatric version of the Sequential Organ Failure Assessment score (pSOFA) within 24 h of blood culture collection. A nomogram based on logistic regression models was constructed to predict the risk factors for sepsis in children with Staphylococcus aureus bloodstream infections. It was validated using the area under the receiver-operating characteristic curve (AUC). Results Of the 94 patients included in the study, 35 cases (37.2%) developed sepsis. The pSOFA scores ranged from 0 to 8, with 35 patients having a pSOFA score of ≥ 2. Six children (6.4%) died within 30 days, who were all from the sepsis group and had different pSOFA scores. The most common organs involved in sepsis in children with staphylococcal bloodstream infections were the neurologic system (68.6%), respiratory system (48.6%), and coagulation system (45.7%). Hospital-acquired infections (adjusted odds ratio [aOR], 3.0; 95% confidence interval [CI], 1.3–7.2), implanted catheters (aOR, 10.4; 95% CI, 3.8–28.4), procalcitonin level ≥ 1.7 ng/mL (aOR, 15.4; 95% CI, 2.7–87.1), and underlying diseases, especially gastrointestinal malformations (aOR, 14.0; 95% CI, 2.9–66.7) were associated with Staphylococcus aureus sepsis. However, methicillin-resistant Staphylococcus aureus infection was not a risk factor for sepsis. The nomogram had high predictive accuracy for the estimation of sepsis risk, with an AUC of 0.85. Conclusions We developed a predictive model for sepsis in children with Staphylococcus aureus infection.