Padman Jayaratne

Outbreaks of infection caused by community- acquired methicillin-resistant Staphylococcus aureus in a Canadian correctional facility

BACKGROUND Methicillin-resistant Staphylococcus aureus (MRSA) has been identified in prison settings in the United States. The present study investigated two clusters of skin and soft tissue infection caused by community-acquired (CA) MRSA in a correctional facility in southern Ontario. METHODS Outbreak investigations were conducted by the responsible public health authority. Strain relatedness was assessed through comparison of pulsed-field gel electrophoresis and antibiograms. RESULTS Two distinct outbreaks of CAMRSA-associated disease occurred in 2002 and 2004. Most patients presented with abscesses in the lower extremities. All isolates had identical DNA banding patterns on pulsed-field gel electrophoresis. One-half of the affected inmates resided in a cellblock with one other affected inmate. No other risk factors were identified. CONCLUSIONS One of the first outbreaks of CAMRSA infections in a correctional facility in Canada is documented. Taken in conjunction with outbreaks elsewhere, this suggests that residence in correctional facilities may be a risk factor for CAMRSA infection.

Mutations in cholesteryl ester transfer protein and hepatic lipase in a North American population

OBJECTIVE To examine a North American population sample with increased HDL cholesterol for mutations in the genes coding for cholesteryl ester transfer protein (CETP) and hepatic lipase (HL). DESIGN AND METHODS Seventy individuals with increased HDL cholesterol at the time of initial presentation to the Lipid Clinic (males > 1.7 mmol/L, females > 1.8 mmol/L) were examined by polymerase chain reaction-restriction fragment length polymorphism (PCR/RFLP) analysis for known mutations in CETP intron 14 and exon 15 and HL exons 6 and 8. RESULTS CETP intron 14 mutation frequency 0.7%, CETP exon 15 A1503G 0%, HL exon 6 C873T 2.1%, HL exon 8 C1221T 0%. An unusual mutation in CETP exon 15 G1533A was found at a frequency of 3.5%. The sequence of this mutation was determined to be a G to A change at bp 1533 resulting in a predicted amino acid change of arginine to glutamine at position 451. CONCLUSIONS Known mutations in CETP were much less prevalent in this North American population than in the Japanese populations that have been previously reported. HL mutations, described previously in only 6 families worldwide, appear to be more prevalent than previously recognized. CETP G1533A, reported only once previously is prevalent in this population at a surprisingly high frequency. The functional significance of this mutation is unknown.

Detection of methicillin-resistant Staphylococcus aureus (MRSA) from growth on mannitol salt oxacillin agar using PCR for nosocomial surveillance.

This study evaluated a polymerase chain reaction (PCR) method for detection of methicillin-resistant Staphylococcus aureus (MRSA) in specimens referred for nosocomial surveillance. PCR was used to detect the mecA and nuc gene targets using yellow growth on mannitol salt agar containing 6 mg/liter oxacillin (MSO-6) as a source of DNA (N = 645). The diagnostic values for PCR compared with culture methods were 97% specificity, 100% sensitivity, 96% positive predictive value, and 100% negative predictive value. Total cost for PCR per test is

Real-time polymerase chain reaction method for detection of toxigenic Clostridium difficile from stools and presumptive identification of NAP1 clone.

3.62 compared to

Molecular Analysis of Vancomycin-Resistant Enterococci Isolated from Regional Hospitals in Trinidad and Tobago

4.77 for culture. However, the total cost per specimen is significantly lower due to only 20% of all surveillance specimens producing yellow colonies on MSO-6. The average turnaround time for the PCR method is 48 h compared with 82 h for culture. PCR amplification of mecA and nuc genes using yellow colonies on MSO-6 is a simple, fast, accurate and cost-effective method for routine use in clinical laboratories for detecting MRSA in surveillance specimens.

Molecular characterization of vancomycin-resistant Enterococcus faecium isolates from Bermuda

This study describes the development of a cost-effective, multiplex real-time polymerase chain reaction (RTPCR) method for detection of toxigenic Clostridium difficile from stools and presumptive identification of the NAP-1 strain. The diagnostic value of the new method is for the detection of toxigenic C. difficile which has the following performance characteristics: 99.8% specificity, 95.1% sensitivity, 97.5% positive predictive value, and 99.5% negative predictive value. Examination of 24 specimens presumptively identified as NAP1 strain by RTPCR with Pulsed-field gel electrophoresis performed on C. difficile isolated from those specimens showed 100% agreement. This RTPCR showed equivalent test performance characteristics as the 2 commercially available assays which were evaluated. The estimated cost per test is CAD

Genetic characteristics and molecular epidemiology of vancomycin-resistant Enterococci isolates from Caribbean countries

9.50 and which is significantly less than the commercial assays. The average turnaround time from setup to detection is 3.5 h. The RTPCR method described here is a cost-effective and highly sensitive test which can be implemented in a clinical laboratory to assist clinicians in establishing the diagnosis of C. difficile infection and indirectly determine the presence of the hypervirulent epidemic binary toxin (BI)/NAP 1 strain for prompt infection control interventions.

Usefulness of Pulsed Field Gel Electrophoresis Assay in the Molecular Epidemiological Study of Extended Spectrum Beta Lactamase Producers

Geographic spread of vancomycin-resistant enterococci (VRE) clones in cities, countries, or even continents has been identified by molecular techniques. This study aimed at characterizing virulent genes and determining genetic relatedness of 45 VRE isolates from Trinidad and Tobago using molecular tools, including polymerase chain reaction, pulsed-field gel electrophoresis (PFGE), and Random Amplification Polymorphic DNA (RAPD). The majority (84%) of the isolates were Enterococcus faecium possessing vanA gene while the rest (16%) were Enterococcus faecalis possessing vanB. The esp gene was found in all 45 VRE isolates while hyl genes were found only in E. faecium species. The E. faecium species expressed five distinct PFGE patterns. The predominant clones with similar or common patterns belonged to clones one and three, and each had 11 (29%) of the VRE isolates. Plasmid content was identified in representative isolates from each clonal group. By contrast, the E. faecalis species had one PFGE pattern suggesting the presence of an occult and limited clonal spread. The emergence of VRE in the country seems to be related to intra/interhospital dissemination of an epidemic clone carrying the vanA element. Therefore, infection control measures will be warranted to prevent any potential outbreak and spread of VRE in the country.

Molecular epidemiology of methicillin-resistant Staphylococcus aureus isolates from regional hospitals in Trinidad and Tobago

Molecular characteristics of vancomycin resistant enterococci isolates from Bermuda Island is currently unknown. This study was conducted to investigate phenotypic and genotypic characteristics of VRE isolates from Bermuda Island using the chromogenic agar, E-tests, polymerase chain reaction (PCR), pulsed-field gel electrophoresis (PFGE) and multilocus sequence typing (MLST). Eighteen E. faecium isolates were completely analyzed and were all resistant to vancomycin, susceptible to linezolid and quinupristin/dalfopristin, positive for vanA and esp genes. The MLST analysis confirmed most isolates were of the sequence types linked to clonal complex 17 (CC17) that is widely associated with outbreaks in hospitals. Infection control measures, antibiotic stewardship, and surveillance activities will continue to be a priority in hospital on the Island.

Does Extending Clostridium Difficile Treatment In Patients Who Are Receiving Concomitant Antibiotics Reduce The Rate Of Relapse

Emergence of vancomycin-resistant Enterococci (VRE) that first appeared on the stage about three decades ago is now a major concern worldwide as it has globally reached every continent. Our aim was to simply undertake a multinational study to delineate the resistance and virulence genes of clinical isolates of VRE isolates from the Caribbean. We employed both conventional (standard microbiological methods including use of E-test strips, chromogenic agar) and molecular methods (polymerase chain reactions–PCR, pulsed-field gel electrophoresis–PFGE and multilocus sequence typing–MLST) to analyze and characterize 245 Enterococci species and 77 VRE isolates from twelve hospitals from eight countries in the Caribbean. The PCR confirmed and demonstrated the resistance and virulence genes (vanA and esp) among all confirmed VRE isolates. The PFGE delineated clonally related isolates from patients from the same country and other countries in the region. The main sequence types of the VRE isolates from the region included STs 412, 750, 203, 736 and 18, all from the common ancestor for clonal complex 17 (CC17). Despite this common ancestor and association of outbreaks of this lineage clones, there has been no reports of outbreaks of infection by VRE in several hospitals in the Caribbean.