A new method for estimating the time to colonization of Methicillin-resistant Staphylococcus Aureus (MRSA) patients is developed in this paper. The time to colonization of MRSA is modelled using a Bayesian smoothing approach for the hazard function. There are two prior models discussed in this paper: the first difference prior and the second difference prior. The second difference prior model gives smoother estimates of the hazard functions and, when applied to data from an intensive care unit (ICU), clearly shows increasing hazard up to day 13, then a decreasing hazard. The results clearly demonstrate that the hazard is not constant and provide a useful quantification of the effect of length of stay on the risk of MRSA colonization which provides useful insight.
In the course of our chemotaxonomic study of the liverworts growing in Madagascar, mastigophoric acid methyl ester, along with eleven known compounds were isolated from Mastigophora diclados. Isolated metabolites showed that the Malagasy Mastigophora is more related to the samples from Borneo and Japan than to the Taiwanese or Malaysian ones. The biosynthesis of the herbertane type sesquiterpenoids from Mastigophora diclados is suggested to be similar to those found in the genus Herbertus. The herbertane-type sesquiterpenoids were screened for Staphylococcus aureus strain inhibition.
Matched MeSH terms: Staphylococcus aureus/drug effects; Staphylococcus aureus/growth & development
This is the first time we encountered a peculiar case of osteomyelitis complicating a closed fracture. The patient was a 38 year-old lady who presented just like any other patient with a closed fracture of the right femur. Intraoperatively we were surprised to find pus from the fracture site. This not only changed the surgical management but altered the subsequent outcome as well.
Cellulitis of the orbit is a common cause of proptosis in children, and also frequently arises in the elderly and the immunocompromised. The condition is characterized by infection and swelling of the soft tissues lining the eye socket, pushing the eye ball outwards and causing severe pain, redness, discharge of pus and some degree of blurred vision. There is a small risk of infection spreading to the meninges of the brain and causing meningitis. This paper reports the case of an adult in whom polymicrobial bilateral orbital cellulitis had developed due to Staphylococcus aureus and Neisseria gonorrhoeae infection. N. gonorrhoeae infections are acquired by sexual contact. Although the infection may disseminate to a variety of tissues, it usually affects the mucous membranes of the urethra in males and the endocervix and urethra in females. To the authors' knowledge this is the first report of polymicrobial bilateral orbital cellulitis due to S. aureus and N. gonorrhoeae in medical literature.
The in-vitro susceptibility of quinupristin/dalfopristin, levofloxacin and moxifloxacin against methicillin-resistant Staphylococcus aureus (MRSA) strains, which are also resistant to fusidic acid and rifampicin were carried out to determine whether these antibiotics can be used as an alternative treatment for multiply resistant MRSA strains. The minimum inhibitory concentrations (MIC) of these antibiotics were determined by E-test. Quinupristin/dalfopristin had good activity (MIC90 = 1 mg/L) against these strains while most of the strains showed intermediate resistance to moxifloxacin with MIC90 = 2 mg/L). However, more than 90% of these strains were resistant to levofloxacin with the MICs that ranged from 8 mg/L to 16 mg/L with the majority inhibited at 8 mg/L.
Medicinal plants have many traditional claims including the treatment of ailments of infectious origin. In the evaluation of traditional claims, scientific research is important. The objective of the study was to determine the presence of antibacterial activity in the crude extracts of some of the commonly used medicinal plants in Malaysia, Andrographis paniculata, Vitex negundo, Morinda citrifolia, Piper sarmentosum, and Centella asiatica. In this preliminary investigation, the leaves were used and the crude extracts were subjected to screening against five strains of bacteria species, Methicillin Resistant Staphylococcus aureus (MRSA), Staphylococcus aureus, Klebsiella pneumoniae, Pseudomonas aeruginosa and Escherichia coli, using standard protocol of Disc Diffusion Method (DDM). The antibacterial activities were assessed by the presence or absence of inhibition zones and MIC values. M. citrifolia, P. sarmentosum and C. asiatica methanol extract and A. paniculata (water extract) have potential antibacterial activities to both gram positive S. aureus and Methicillin Resistant S. aureus (MRSA). None of the five plant extracts tested showed antibacterial activities to gram negative E. coli and K. pneumoniae, except for A. paniculata and P. sarmentosum which showed activity towards P. aeruginosa. A. paniculata being the most potent at MIC of 2 g/disc. This finding forms a basis for further studies on screening of local medicinal plant extracts for antibacteria properties.
We describe a patient who had fever and bilateral cortical blindness and was later found to have leaking intracerebral mycotic aneurysm secondary to Staphylococcus aureus endocarditis. He had a vegetation at the .tricuspid valve with evidence of systemic embolisation, however, chest radiograph did not reveal any evidence of pulmonary emboli.
Keywords: Endocarditis, cortical blindness, mycotic aneurysm, Staphylococcus
Infection plays a pivotal role in enhancing a diabetic foot at risk toward amputation. Effective antibiotic therapy against the offending pathogens is an important component of treatment of diabetic foot infections. Recognition of the pathogen is always difficult as the representative deep tissue sample for culture is surrounded by ulcer surface harbouring colonies of organisms frequently labelled as skin commensals. The emergent of resistant strains represents a compounding problem standing against efforts to prevent amputation. This study was undertaken to identify the pathogens associated with diabetic foot infection in terms of their frequency and sensitivity against certain commonly used antibiotics. Forty-four consecutive patients with open diabetic foot infections had wound swab taken for culture and sensitivity testing. Cultures positive were observed in 89% of the cases with Staphylococcus aureus, Klebsiella pneumoniae, Pseudomonas aeroginosa encountered in 20%, 14% and 14% of cases respectively. Mixed growths were isolated in 6% of cultures. All Staphylcoccus aureus isolates were resistant to Penicillin but 80% were sensitive to Erythromycin and Co-trimoxazole. Klebsiella pneumoniae isolates were sensitive to Methicillin and Gentamycin in 80% and 60% of cases respectively, and resistant to Ampicillin and Ceftazidime in 83% and 50% respectively. All Pseudomonas aeroginosa isolates were sensitive to Amikacin and Ciprofloxacin but 50% were resistant to Gentamycin. There was no single antibiotic possessing good coverage for all common organisms isolated from diabetic foot lesions. Staphylococcus aureus remains the predominant cause of diabetic foot infections followed by Klebsiela pneumonia and Pseudomonas aeroginosa. Most infections are monomicrobial. The emergence of multiresistant organisms is a worrying feature in diabetic foot infections.
We report a 17-year-old Malay boy with cystic fibrosis who over a 14-month period experienced worsening respiratory symptoms and deteriorating lung function. Burkholderia pseudomallei was eventually isolated from his sputum. He improved clinically following treatment for meliodosis and his lung function returned to normal.
Diagnosis and treatment of acute tonsillitis are one of the most common problems seen at an otorhinolaryngology clinic in both adult and paediatric populations. Much has been written about bacteriology of recurrent tonsillitis but it remains a controversial topic. Despite the fact that tonsillitis is so common, consensus seems to be lacking as to the main causative organism and the differences between children and adults. The tonsillar core bacteriology of 233 patients with recurrent tonsillitis who underwent tonsillectomy from January 2000 to June 2003 is presented.
Study site: inpatients, University Malaya Medical Centre (UMMC), Kuala Lumpur, Malaysia
For rapid identification of methicillin-resistant Staphylococcus aureus, molecular methods are generally targeting mecA and species-specific genes. Sa442 DNA fragment is a popular species-specific target. However, recently, there have been few reports on S. aureus isolates that are negative for Sa442 fragment; therefore, use of single gene or DNA-fragment-specific polymerase chain reaction (PCR) for identification of microbial isolate may result in misidentification. This study includes CoA gene in parallel with Sa442 marker for identification of S. aureus. This further improves the specificity of the assay by checking for 2 determinants simultaneously for the identification of S. aureus and can prevent misidentification of S. aureus isolates lacking Sa442 DNA fragment. In this study, the newly developed triplex real-time PCR assay was compared with a quadruplex conventional gel-based PCR assay using the same primer sets in both assays. The dual-labeled TaqMan probes (ProOligo, France) for these primers were specifically designed and used in a real-time PCR assay. The clinical isolates (n = 152) were subjected to both PCR assays. The results obtained from both assays proved that the primer and probe sets were 100% sensitive and 100% specific for identification of S. aureus and detection of methicillin resistance. This triplex real-time PCR assay represents a rapid and powerful method for S. aureus identification and detection of methicillin resistance.
Data on the carriage rate and antibiotic sensitivity pattern of Staphylococcus aureus strains prevalent in the community are not available for many developing countries including Malaysia. To estimate the extent of community S. aureus transmission, in particular methicillin-resistant S. aureus (MRSA), the prevalence of S. aureus nasal colonization in a population of healthy adults was determined. Factors associated with S. aureus nasal carriage and antibiotic sensitivity patterns of the isolates were also analyzed.
This is a prospective study on infection following fixation of closed fractures done in Hospital Tengku Ampuan Afzan ,Kuantan from May 2003 to May 2005. There were 23 cases in this study. The mean age of patient was 32.9 years (range 15 to 77). Twenty one were males and 2 females. Twenty (87%) infections occurred in the lower limb and only 3(13%) occurred in the upper limbs. Twenty two patients (91%) had plating done for the fracture. Infection following internal fixation is commonly a deep seated (96%) and florid (78%) infection in which 70% occur after the surgical wound has healed. Staphylococcus aureus is the commonest organism isolated in which 43% are Methicillin resistant (MRSA). Overall infection caused by gram negative organisms is more common than gram positive organisms.
Natural peptides in insect vectors played an important role in the control of
pathogens. Musca domestica Linnaeus and Chrysomya megacephala Fabricius were
two species of local fly chosen to detect presence of antimicrobial peptide substance.
The screening of the antimicrobial activity was carried using a spectrophotometric
method. Results were obtained much quicker and less laborious. The results showed
larva hemolymph of M. domestica lysed Bacillus subtilis and two Gram negatives,
Escherichia coli and Pseudomona. aeruginosa. The pupae hemolymph only lysed E.
coli. Whereas, the hemolymph of C. megacephala larva showed bactericidal effect
against both of the Gram positives tested, i.e. B. subtilis and Staph. aureus. and no
effect was against the Gram negatives. The pupa showed lytic activity against Staph.
aureus and P. aeruginosa. As a conclusion, the larva and pupa hemolymph of M.
domestica and C. megacephala demonstrated antibacterial activity. However, larva
hemolymph of M. domestica and C. megacephala has broader antibacterial activity
against both Gram positive and negative bacteria.
In this study we describe a triplex real-time PCR assay that enables the identification of S. aureus and detection of two important antibiotic resistant genes simultaneously using real-time PCR technology in a single assay. In this triplex real-time PCR assay, the mecA (methicillin resistant), femA (species specific S. aureus) and aacA-aphD (aminoglycoside resistant) genes were detected in a single test using dual-labeled Taqman probes. The assay gives simultaneous information for the identification of S. aureus and detection of methicillin and aminoglycoside resistance in staphylococcal isolates. 152 clinical isolates were subjected to this triplex real-time PCR assay. The results of the triplex real-time PCR assay correlated with the results of the phenotypic antibiotic susceptibility testing. The results obtained from triplex real-time PCR assay shows that the primer and probe sets were specific for the identification of S. aureus and were able to detect methicillin- and aminoglycoside-resistant genes. The entire assay can be performed within 3 h which is a very rapid method that can give simultaneous information for the identification of S. aureus and antibiotic resistance pattern of a staphylococcal isolate. The application of this rapid method in microbiology laboratories would be a valuable tool for the rapid identification of the S. aureus isolates and determination of their antibiotic resistance pattern with regards to methicillin and aminoglycosides.
A triplex real-time polymerase chain reaction (PCR) assay was used for the simultaneous detection of mecA (methicillin resistance), ermA (erythromycin resistance) and femA (Staphylococcus aureus identification) genes in a single assay. Among 93 clinical S. aureus hospital isolates, there were 48 methicillin-resistant S. aureus (MRSA) and 45 methicillin-sensitive S. aureus (MSSA) isolates. Screening the isolates using the triplex real-time PCR assay, the mecA, ermA and femA genes were detected in all MRSA isolates. The triplex real-time PCR assay was completed within 3h and is a useful genotypic method for detecting the resistance determinants as well as for the identification of S. aureus isolates. These findings will assist the clinical laboratory in identifying these resistance genes and S. aureus rapidly, thus benefiting patient therapy. This study represents a valuable source of information for researchers to study the local antibiotic resistance pattern, which can increase our knowledge of the antibiotic resistance profile, using real-time PCR technology.
Mesosomes of Staphylococcus aureus ATCC 25923 treated with antibiotics were examined morphologically under the electron microscope. The Transmission Electron Microscope Rapid Method was used to eliminate the artifacts due to sample processing. Mesosomes were seen in all the antibiotic treated bacteria and not in the control group. The main factor that contributes to the formation of mesosomes in the bacteria was the mode of action of the antibiotics. The continuous cytoplasmic membrane with infolding (mesosomes) as in the S. aureus ATCC 25923 is therefore confirmed as a definite pattern of membrane organization in gram positive bacteria assaulted by amikacin, gentamicin, ciprofloxacin, vancomycin and oxacillin antibiotics. Our preliminary results show oxacillin and vancomycin treated bacteria seemed to have deeper and more mesosomes than those treated with amikacin, gentamicin and ciprofloxacin. Further research is needed to ascertain whether the deep invagination and the number of mesosomes formed is associated with the types of antibiotic used.
A 12-year old girl presented with an unusual problem of recurrent discharging multiple skin sinuses on her right anterior and posterior chest wall for a year. There was ipsilateral lower lobe pneumonia and imaging showed multiple abscesses in her lower back muscles bilaterally. A purulent fluid was aspirated from her back muscles and the histology examination showed sulphur granules with gram positive branched filaments. She responded well to the treatment for actinomycosis with penicillin and doxycycline.
Two species of plants, Andrographis paniculata and Euphorbia hirta were screened for antibacterial activities against three Gram positives and Gram negatives. The leaves from both plants were extracted by methanol extraction. The antibacterial activity was detected with spread plate well diffusion method. The extracts of both plants demonstrated inhibitory activity against both Gram negative and positives bacteria. Staphylococcus aureus, Bacillus subtilis, Streptococcus epidemidis, Escherichia coli, Klebsiella pneumoniae and Pseudomonas aeruginosa. The minimum inhibitory concentration (MIC determination using micro dilution method showed that the A/tic of A. paniculata for the tested bacteria were 1.56 mg/ml (Staph. aureus), 3.13 mg/ml (Bacillus subtilis), 3.13 mg/ml (Strept. epidemidis), 1.56 mg/ml (Escherichia cob), 12.50 mg/ml (Klebsiella pneumoniae) and 3.13 mg/ml (Pseudomonas aeruginosa) respectively. The MIC value for E. hirta was 6.25 mg/ml (Staph. aureus) and 3.13 mg/ml (Bacillus subtilis), 3.13 mg/ml (Strept. Epidemidis), 3.13 mg/ml (Pseudomonas aeruginosa),12.5 mg/ml (Escherichia coli), and 6.25 mg/ml (Klebsiella pneumoniae). Both plants represent a potential for pharmaceutical and agricultural applications and are worthy of further study.