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Frédéric Laurent - One of the best experts on this subject based on the ideXlab platform.
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Sources and reservoirs of Staphylococcus Capitis NRCS-A inside a NICU.
Antimicrobial resistance and infection control, 2019Co-Authors: Marine Butin, J. C. Picaud, Yann Dumont, Patricia Martins Simoes, Alice Monteix, Aurane Raphard, Christine Roques, Frédéric LaurentAbstract:The methicillin-resistant clone Staphylococcus Capitis NRCS-A, involved in sepsis in neonatal intensive care units (NICUs) worldwide, is able to persist and spread in NICUs, suggesting the presence of reservoirs inside each setting. The purpose of the present study was to identify these reservoirs and to investigate the cycle of transmission of NRCS-A in one NICU. In a single institution study, NRCS-A was sought in 106 consecutive vaginal samples of pregnant women to identify a potential source of NRCS-A importation into the NICU. Additionally NICU caregivers and environmental including incubators were tested to identify putative secondary reservoirs. Finally, the efficacy of disinfection procedure in the elimination of NRCS-A from incubators was evaluated. No S. Capitis was isolated from vaginal samples of pregnant women. Three of the 21 tested caregivers (14%) carried S. Capitis on their hands, but none remain positive after a five-day wash-out period outside NICU. Moreover, the clone NRCS-A persisted during six consecutive weeks in the NICU environment, but none of the sampled sites was constantly contaminated. Finally in our before/after disinfection study, all of 16 incubators were colonized before disinfection and 10 (62%) incubators remained colonized with NRCS-A after the disinfection procedure. The partial ineffectiveness of incubators’ disinfection procedures is responsible for persistence of NRCS-A inside a NICU, and the passive hand contamination of caregivers could be involved in the inter-patient transmission of S. Capitis.
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successful implementation of infection control measure in a neonatal intensive care unit to combat the spread of pathogenic multidrug resistant Staphylococcus Capitis
Antimicrobial Resistance and Infection Control, 2019Co-Authors: Jérôme Ory, Frédéric Laurent, M. Cazaban, Massimo Di Maio, Alix Pantel, Albert Sotto, Jean-philippe Lavigne, Brigitte Richaudmorel, Catherine Dunyachremy, Marine ButinAbstract:Once present in a neonatal intensive care unit (NICU), multidrug resistant Staphylococcus Capitis NRCS-A is able to settle and diffuse. The objective of this study was to evaluate the impact of infection control (IC) interventions to reduce the spread of Staphylococcus Capitis NRCS-A in a NICU. Between December 2012 and December 2017, all patients presenting positive sampling (blood, skin or catheter) to S. Capitis were included, and clinical data were recorded from electronic clinical charts. The IC team has continually implemented measures of control infections (hand hygiene, standard precautions, patient contact isolation and disinfection of the inanimate environment). From May 2015, a steam cleaner was implemented in the cleaning procedure instead of disinfectant to disinfect heating tables and incubators. Four periods were determined: Period 1 (P1) before steam cleaner acquisition; Period 2 (P2) after implementation steam cleaner; Period 3 (P3) when the steam cleaner had broken down, and Period 4 (P4) when the steam cleaner was functional again. The consumption of antibiotics and the epidemiology of infections inside the NICU were investigated during the study period. During the studied period, 37 infants were infected or colonized by S. Capitis. The incidences of infection or colonization by S. Capitis were P1 = 1.04‰, P2 = 0.55‰, P3 = 3.95 ‰ and P4 = 0‰ and were significantly different between P1-P3 and P2-P4 (p < 0.001). During the different periods, antibiotics consumption and bacterial epidemiology of the ward were stable. The use of steam vapor system was associated with a significantly decreased incidence of S. Capitis NRCS-A infection or colonization and could constitute an effective and safe procedure to control and eradicate its diffusion inside NICUs.
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Staphylococcus Capitis and NRCS-A clone: the story of an unrecognized pathogen in neonatal intensive care units.
Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases, 2019Co-Authors: Frédéric Laurent, Marine ButinAbstract:Abstract Background In neonatal intensive care units (NICUs), nosocomial late-onset sepsis (LOS), mostly due to coagulase negative staphylococci, constitute a major cause of death or impairment. Staphylococcus Capitis, usually considered as a poorly virulent species, has been reported as a cause of LOS. Objectives To review data regarding S. Capitis neonatal LOS and the features of isolates involved. Sources PubMed was searched up to August 2018 to retrieve studies on the topic; the keywords used were ‘S. Capitis’, ‘neonate’, ‘neonatal ICU’, ‘bloodstream infection’ and ‘late onset sepsis’. Content Published data highlight the worldwide endemicity of a single S. Capitis clone, named NRCS-A, specifically involved in LOS. NRCS-A harbours a multidrug resistance profile (including resistance to the usual first-line antibiotics used in NICUs). It is also able to adapt under vancomycin selective pressure that could confer an advantage for its implantation and dissemination in NICUs where this selective pressure is high. Moreover, a severe morbidity has been observed in NRCS-A-related LOS. The NICU environment, and especially incubators, constitute reservoirs of NRCS-A from which it could diffuse inside the setting. Finally, the virulome and resistome of S. Capitis NRCS-A contain many genes potentially implicated in its specific epidemiology and pathophysiology, including the gene nsr that may be involved in its fitness and implantation in neonatal gut flora. Implications S. Capitis must be considered as a true pathogen in neonates. The decreased susceptibility to vancomycin may be involved in failure of vancomycin therapy. Further studies are needed to better manage its diffusion inside each NICU but also worldwide.
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Successful implementation of infection control measure in a neonatal intensive care unit to combat the spread of pathogenic multidrug resistant Staphylococcus Capitis
Antimicrobial resistance and infection control, 2019Co-Authors: Jérôme Ory, Frédéric Laurent, M. Cazaban, Brigitte Richaud-morel, Massimo Di Maio, Catherine Dunyach-remy, Alix Pantel, Albert Sotto, Jean-philippe Lavigne, Marine ButinAbstract:Once present in a neonatal intensive care unit (NICU), multidrug resistant Staphylococcus Capitis NRCS-A is able to settle and diffuse. The objective of this study was to evaluate the impact of infection control (IC) interventions to reduce the spread of Staphylococcus Capitis NRCS-A in a NICU. Between December 2012 and December 2017, all patients presenting positive sampling (blood, skin or catheter) to S. Capitis were included, and clinical data were recorded from electronic clinical charts. The IC team has continually implemented measures of control infections (hand hygiene, standard precautions, patient contact isolation and disinfection of the inanimate environment). From May 2015, a steam cleaner was implemented in the cleaning procedure instead of disinfectant to disinfect heating tables and incubators. Four periods were determined: Period 1 (P1) before steam cleaner acquisition; Period 2 (P2) after implementation steam cleaner; Period 3 (P3) when the steam cleaner had broken down, and Period 4 (P4) when the steam cleaner was functional again. The consumption of antibiotics and the epidemiology of infections inside the NICU were investigated during the study period. During the studied period, 37 infants were infected or colonized by S. Capitis. The incidences of infection or colonization by S. Capitis were P1 = 1.04‰, P2 = 0.55‰, P3 = 3.95 ‰ and P4 = 0‰ and were significantly different between P1-P3 and P2-P4 (p
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Successful implementation of infection control measure in a neonatal intensive care unit to combat the spread of pathogenic multidrug resistant Staphylococcus Capitis
BMC, 2019Co-Authors: Jérôme Ory, Frédéric Laurent, M. Cazaban, Brigitte Richaud-morel, Massimo Di Maio, Catherine Dunyach-remy, Alix Pantel, Albert Sotto, Jean-philippe Lavigne, Marine ButinAbstract:Abstract Background Once present in a neonatal intensive care unit (NICU), multidrug resistant Staphylococcus Capitis NRCS-A is able to settle and diffuse. Objective The objective of this study was to evaluate the impact of infection control (IC) interventions to reduce the spread of Staphylococcus Capitis NRCS-A in a NICU. Methods Between December 2012 and December 2017, all patients presenting positive sampling (blood, skin or catheter) to S. Capitis were included, and clinical data were recorded from electronic clinical charts. The IC team has continually implemented measures of control infections (hand hygiene, standard precautions, patient contact isolation and disinfection of the inanimate environment). From May 2015, a steam cleaner was implemented in the cleaning procedure instead of disinfectant to disinfect heating tables and incubators. Four periods were determined: Period 1 (P1) before steam cleaner acquisition; Period 2 (P2) after implementation steam cleaner; Period 3 (P3) when the steam cleaner had broken down, and Period 4 (P4) when the steam cleaner was functional again. The consumption of antibiotics and the epidemiology of infections inside the NICU were investigated during the study period. Results During the studied period, 37 infants were infected or colonized by S. Capitis. The incidences of infection or colonization by S. Capitis were P1 = 1.04‰, P2 = 0.55‰, P3 = 3.95 ‰ and P4 = 0‰ and were significantly different between P1-P3 and P2-P4 (p
Marine Butin - One of the best experts on this subject based on the ideXlab platform.
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Presence of the neonatal Staphylococcus Capitis outbreak clone (NRCS-A) in prosthetic joint infections.
Scientific reports, 2020Co-Authors: Staffan Tevell, Marine Butin, Bengt Hellmark, Åsa Nilsdotter-augustinsson, Bo Söderquist, Patricia Martins Simoes, Thierry Wirth, Sharmin Baig, Marc SteggerAbstract:Staphylococcus Capitis is a coagulase-negative Staphylococcus that has been described primarily as causing bloodstream infections in neonatal intensive care units (NICUs), but has also recently been described in prosthetic joint infections (PJIs). The multidrug-resistant S. Capitis subsp. urealyticus clone NRCS-A, comprising three sublineages, is prevalent in NICUs across the world, but its impact on other patient groups such as those suffering from PJIs or among adults planned for arthroplasty is unknown. Genome sequencing and subsequent analysis were performed on a Swedish collection of PJI isolates (n = 21), nasal commensals from patients planned to undergo arthroplasty (n = 20), NICU blood isolates (n = 9), operating theatre air isolates (n = 4), and reference strains (n = 2), in conjunction with an international strain collection (n = 248). The NRCS-A Outbreak sublineage containing the composite type V SCCmec-SCCcad/ars/cop element was present in PJIs across three Swedish hospitals. However, it was not found among nasal carrier strains, where the less virulent S. Capitis subsp. Capitis was most prevalent. The presence of the NRCS-A Outbreak clone in adult patients with PJIs demonstrates that dissemination occurs beyond NICUs. As this clone has several properties which facilitate invasive infections in patients with medical implants or immunosuppression, such as biofilm forming ability and multidrug resistance including heterogeneous glycopeptide-intermediate susceptibility, further research is needed to understand the reservoirs and distribution of this hospital-associated pathogen.
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Sources and reservoirs of Staphylococcus Capitis NRCS-A inside a NICU.
Antimicrobial resistance and infection control, 2019Co-Authors: Marine Butin, J. C. Picaud, Yann Dumont, Patricia Martins Simoes, Alice Monteix, Aurane Raphard, Christine Roques, Frédéric LaurentAbstract:The methicillin-resistant clone Staphylococcus Capitis NRCS-A, involved in sepsis in neonatal intensive care units (NICUs) worldwide, is able to persist and spread in NICUs, suggesting the presence of reservoirs inside each setting. The purpose of the present study was to identify these reservoirs and to investigate the cycle of transmission of NRCS-A in one NICU. In a single institution study, NRCS-A was sought in 106 consecutive vaginal samples of pregnant women to identify a potential source of NRCS-A importation into the NICU. Additionally NICU caregivers and environmental including incubators were tested to identify putative secondary reservoirs. Finally, the efficacy of disinfection procedure in the elimination of NRCS-A from incubators was evaluated. No S. Capitis was isolated from vaginal samples of pregnant women. Three of the 21 tested caregivers (14%) carried S. Capitis on their hands, but none remain positive after a five-day wash-out period outside NICU. Moreover, the clone NRCS-A persisted during six consecutive weeks in the NICU environment, but none of the sampled sites was constantly contaminated. Finally in our before/after disinfection study, all of 16 incubators were colonized before disinfection and 10 (62%) incubators remained colonized with NRCS-A after the disinfection procedure. The partial ineffectiveness of incubators’ disinfection procedures is responsible for persistence of NRCS-A inside a NICU, and the passive hand contamination of caregivers could be involved in the inter-patient transmission of S. Capitis.
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Successful implementation of infection control measure in a neonatal intensive care unit to combat the spread of pathogenic multidrug resistant Staphylococcus Capitis
Antimicrobial resistance and infection control, 2019Co-Authors: Jérôme Ory, Frédéric Laurent, M. Cazaban, Brigitte Richaud-morel, Massimo Di Maio, Catherine Dunyach-remy, Alix Pantel, Albert Sotto, Jean-philippe Lavigne, Marine ButinAbstract:Once present in a neonatal intensive care unit (NICU), multidrug resistant Staphylococcus Capitis NRCS-A is able to settle and diffuse. The objective of this study was to evaluate the impact of infection control (IC) interventions to reduce the spread of Staphylococcus Capitis NRCS-A in a NICU. Between December 2012 and December 2017, all patients presenting positive sampling (blood, skin or catheter) to S. Capitis were included, and clinical data were recorded from electronic clinical charts. The IC team has continually implemented measures of control infections (hand hygiene, standard precautions, patient contact isolation and disinfection of the inanimate environment). From May 2015, a steam cleaner was implemented in the cleaning procedure instead of disinfectant to disinfect heating tables and incubators. Four periods were determined: Period 1 (P1) before steam cleaner acquisition; Period 2 (P2) after implementation steam cleaner; Period 3 (P3) when the steam cleaner had broken down, and Period 4 (P4) when the steam cleaner was functional again. The consumption of antibiotics and the epidemiology of infections inside the NICU were investigated during the study period. During the studied period, 37 infants were infected or colonized by S. Capitis. The incidences of infection or colonization by S. Capitis were P1 = 1.04‰, P2 = 0.55‰, P3 = 3.95 ‰ and P4 = 0‰ and were significantly different between P1-P3 and P2-P4 (p
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Staphylococcus Capitis and NRCS-A clone: the story of an unrecognized pathogen in neonatal intensive care units.
Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases, 2019Co-Authors: Frédéric Laurent, Marine ButinAbstract:Abstract Background In neonatal intensive care units (NICUs), nosocomial late-onset sepsis (LOS), mostly due to coagulase negative staphylococci, constitute a major cause of death or impairment. Staphylococcus Capitis, usually considered as a poorly virulent species, has been reported as a cause of LOS. Objectives To review data regarding S. Capitis neonatal LOS and the features of isolates involved. Sources PubMed was searched up to August 2018 to retrieve studies on the topic; the keywords used were ‘S. Capitis’, ‘neonate’, ‘neonatal ICU’, ‘bloodstream infection’ and ‘late onset sepsis’. Content Published data highlight the worldwide endemicity of a single S. Capitis clone, named NRCS-A, specifically involved in LOS. NRCS-A harbours a multidrug resistance profile (including resistance to the usual first-line antibiotics used in NICUs). It is also able to adapt under vancomycin selective pressure that could confer an advantage for its implantation and dissemination in NICUs where this selective pressure is high. Moreover, a severe morbidity has been observed in NRCS-A-related LOS. The NICU environment, and especially incubators, constitute reservoirs of NRCS-A from which it could diffuse inside the setting. Finally, the virulome and resistome of S. Capitis NRCS-A contain many genes potentially implicated in its specific epidemiology and pathophysiology, including the gene nsr that may be involved in its fitness and implantation in neonatal gut flora. Implications S. Capitis must be considered as a true pathogen in neonates. The decreased susceptibility to vancomycin may be involved in failure of vancomycin therapy. Further studies are needed to better manage its diffusion inside each NICU but also worldwide.
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successful implementation of infection control measure in a neonatal intensive care unit to combat the spread of pathogenic multidrug resistant Staphylococcus Capitis
Antimicrobial Resistance and Infection Control, 2019Co-Authors: Jérôme Ory, Frédéric Laurent, M. Cazaban, Massimo Di Maio, Alix Pantel, Albert Sotto, Jean-philippe Lavigne, Brigitte Richaudmorel, Catherine Dunyachremy, Marine ButinAbstract:Once present in a neonatal intensive care unit (NICU), multidrug resistant Staphylococcus Capitis NRCS-A is able to settle and diffuse. The objective of this study was to evaluate the impact of infection control (IC) interventions to reduce the spread of Staphylococcus Capitis NRCS-A in a NICU. Between December 2012 and December 2017, all patients presenting positive sampling (blood, skin or catheter) to S. Capitis were included, and clinical data were recorded from electronic clinical charts. The IC team has continually implemented measures of control infections (hand hygiene, standard precautions, patient contact isolation and disinfection of the inanimate environment). From May 2015, a steam cleaner was implemented in the cleaning procedure instead of disinfectant to disinfect heating tables and incubators. Four periods were determined: Period 1 (P1) before steam cleaner acquisition; Period 2 (P2) after implementation steam cleaner; Period 3 (P3) when the steam cleaner had broken down, and Period 4 (P4) when the steam cleaner was functional again. The consumption of antibiotics and the epidemiology of infections inside the NICU were investigated during the study period. During the studied period, 37 infants were infected or colonized by S. Capitis. The incidences of infection or colonization by S. Capitis were P1 = 1.04‰, P2 = 0.55‰, P3 = 3.95 ‰ and P4 = 0‰ and were significantly different between P1-P3 and P2-P4 (p < 0.001). During the different periods, antibiotics consumption and bacterial epidemiology of the ward were stable. The use of steam vapor system was associated with a significantly decreased incidence of S. Capitis NRCS-A infection or colonization and could constitute an effective and safe procedure to control and eradicate its diffusion inside NICUs.
Jean-philippe Rasigade - One of the best experts on this subject based on the ideXlab platform.
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Niche specialization and spread of Staphylococcus Capitis involved in neonatal sepsis
Nature Microbiology, 2020Co-Authors: Thierry Wirth, Patricia Martins Simões, Jean-philippe Rasigade, Marine Bergot, Bruno Pichon, Maxime Barbier, Laurent Jacob, Rachel Pike, Pierre Tissieres, J. C. PicaudAbstract:The multidrug-resistant Staphylococcus Capitis NRCS-A clone is responsible for sepsis in preterm infants in neonatal intensive care units (NICUs) worldwide. Here, to retrace the spread of this clone and to identify drivers of its specific success, we investigated a representative collection of 250 S. Capitis isolates from adults and newborns. Bayesian analyses confirmed the spread of the NRCS-A clone and enabled us to date its emergence in the late 1960s and its expansion during the 1980s, coinciding with the establishment of NICUs and the increasing use of vancomycin in these units, respectively. This dynamic was accompanied by the acquisition of mutations in antimicrobial resistance- and bacteriocin-encoding genes. Furthermore, combined statistical tools and a genome-wide association study convergently point to vancomycin resistance as a major driver of NRCS-A success. We also identified another S. Capitis subclade (alpha clade) that emerged independently, showing parallel evolution towards NICU specialization and non-susceptibility to vancomycin, indicating convergent evolution in NICU-associated pathogens. These findings illustrate how the broad use of antibiotics can repeatedly lead initially commensal drug-susceptible bacteria to evolve into multidrug-resistant clones that are able to successfully spread worldwide and become pathogenic for highly vulnerable patients.
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Chromogenic detection procedure for the multidrug-resistant, neonatal sepsis-associated clone Staphylococcus Capitis NRCS-A
Diagnostic Microbiology and Infectious Disease, 2018Co-Authors: Marine Butin, Patricia Martins Simões, Jean-philippe Rasigade, J. C. Picaud, Yann Dumont, Louise Hoden, Frédéric LaurentAbstract:The multiresistant Staphylococcus Capitis clone NRCS-A is a major pathogen in neonates worldwide. We show that NRCS-A grows as mauve colonies with a cream-color halo after a 5-day incubation on MRSA Brilliance 2 agar (Oxoid\textregistered). This innovative protocol will ease the screening of clinical and environmental niches of this clone.
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Vancomycin treatment is a risk factor for vancomycin-nonsusceptible Staphylococcus Capitis sepsis in preterm neonates
Clinical Microbiology and Infection, 2017Co-Authors: Marine Butin, Patricia Martins Simões, Jean-philippe Rasigade, J. C. Picaud, François Vandenesch, F. Subtil, C. Pralong, Anne-marie Freydière, Sylvestre Tigaud, Frédéric LaurentAbstract:OBJECTIVES: Multidrug-resistant, vancomycin-nonsusceptible Staphylococcus Capitis is an emerging cause worldwide of late-onset sepsis (LOS) in preterm neonates. The pathophysiology and risk factors for S.~Capitis-related LOS are poorly understood, but we hypothesized that S.~Capitis LOS follows translocation from the gut microbiota rather than catheter invasion. The objective of this study was to investigate the risk factors of S.~Capitis LOS and gut colonization. METHODS: We conducted a prospective single-centre cohort study of patients hospitalized in a tertiary-care unit (Lyon, France) from June 2011 to January 2012. S.~Capitis gut colonization was determined weekly from stool cultures. The determinants of gut colonization and LOS were established by multivariate Cox proportional hazards models. RESULTS: Eighty-three (36.2%) of 229 patients had S.~Capitis-positive stool culture, and 28 (12.2%) developed S.~Capitis LOS during hospitalization. Independent risk factors for S.~Capitis LOS included prior administration of vancomycin independent of a previous LOS episode (hazard ratio 6.44, 95% confidence interval 2.15-19.3, p 0.001) and low birth weight (hazard ratio 0.72 per 100~g increase, 95% confidence interval 0.55-0.95, p 0.02). The prior administration of vancomycin was also an independent risk factor for S.~Capitis colonization (hazard ratio 3.45, 95% confidence interval 2.07-5.76, p \textless0.001), particularly in the first week of life and in noncolonized neonates. CONCLUSIONS: Neonates treated with vancomycin are at a higher risk of LOS caused by vancomycin-nonsusceptible S.~Capitis. The use of vancomycin in neonates must urgently be optimized to limit the selection of vancomycin-nonsusceptible strains, for which alternative antibiotics are lacking.
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Chromogenic detection procedure for the multidrug-resistant, neonatal sepsis-associated clone Staphylococcus Capitis NRCS-A.
Diagnostic microbiology and infectious disease, 2017Co-Authors: Marine Butin, Jean-philippe Rasigade, J. C. Picaud, Yann Dumont, Louise Hoden, Patricia Martins Simoes, Frédéric LaurentAbstract:Abstract The multiresistant Staphylococcus Capitis clone NRCS-A is a major pathogen in neonates worldwide. We show that NRCS-A grows as mauve colonies with a cream-color halo after a 5-day incubation on MRSA Brilliance 2 agar (Oxoid®). This innovative protocol will ease the screening of clinical and environmental niches of this clone.
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Vancomycin treatment is a risk factor for vancomycin-nonsusceptible Staphylococcus Capitis sepsis in preterm neonates
Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases, 2017Co-Authors: Marine Butin, Patricia Martins Simões, Jean-philippe Rasigade, J. C. Picaud, François Vandenesch, F. Subtil, C. Pralong, Anne-marie Freydière, Sylvestre Tigaud, Frédéric LaurentAbstract:Abstract Objectives Multidrug-resistant, vancomycin-nonsusceptible Staphylococcus Capitis is an emerging cause worldwide of late-onset sepsis (LOS) in preterm neonates. The pathophysiology and risk factors for S. Capitis –related LOS are poorly understood, but we hypothesized that S. Capitis LOS follows translocation from the gut microbiota rather than catheter invasion. The objective of this study was to investigate the risk factors of S. Capitis LOS and gut colonization. Methods We conducted a prospective single-centre cohort study of patients hospitalized in a tertiary-care unit (Lyon, France) from June 2011 to January 2012. S. Capitis gut colonization was determined weekly from stool cultures. The determinants of gut colonization and LOS were established by multivariate Cox proportional hazards models. Results Eighty-three (36.2%) of 229 patients had S. Capitis –positive stool culture, and 28 (12.2%) developed S. Capitis LOS during hospitalization. Independent risk factors for S. Capitis LOS included prior administration of vancomycin independent of a previous LOS episode (hazard ratio 6.44, 95% confidence interval 2.15–19.3, p 0.001) and low birth weight (hazard ratio 0.72 per 100 g increase, 95% confidence interval 0.55–0.95, p 0.02). The prior administration of vancomycin was also an independent risk factor for S. Capitis colonization (hazard ratio 3.45, 95% confidence interval 2.07–5.76, p Conclusions Neonates treated with vancomycin are at a higher risk of LOS caused by vancomycin-nonsusceptible S. Capitis. The use of vancomycin in neonates must urgently be optimized to limit the selection of vancomycin-nonsusceptible strains, for which alternative antibiotics are lacking.
J. C. Picaud - One of the best experts on this subject based on the ideXlab platform.
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Niche specialization and spread of Staphylococcus Capitis involved in neonatal sepsis
Nature Microbiology, 2020Co-Authors: Thierry Wirth, Patricia Martins Simões, Jean-philippe Rasigade, Marine Bergot, Bruno Pichon, Maxime Barbier, Laurent Jacob, Rachel Pike, Pierre Tissieres, J. C. PicaudAbstract:The multidrug-resistant Staphylococcus Capitis NRCS-A clone is responsible for sepsis in preterm infants in neonatal intensive care units (NICUs) worldwide. Here, to retrace the spread of this clone and to identify drivers of its specific success, we investigated a representative collection of 250 S. Capitis isolates from adults and newborns. Bayesian analyses confirmed the spread of the NRCS-A clone and enabled us to date its emergence in the late 1960s and its expansion during the 1980s, coinciding with the establishment of NICUs and the increasing use of vancomycin in these units, respectively. This dynamic was accompanied by the acquisition of mutations in antimicrobial resistance- and bacteriocin-encoding genes. Furthermore, combined statistical tools and a genome-wide association study convergently point to vancomycin resistance as a major driver of NRCS-A success. We also identified another S. Capitis subclade (alpha clade) that emerged independently, showing parallel evolution towards NICU specialization and non-susceptibility to vancomycin, indicating convergent evolution in NICU-associated pathogens. These findings illustrate how the broad use of antibiotics can repeatedly lead initially commensal drug-susceptible bacteria to evolve into multidrug-resistant clones that are able to successfully spread worldwide and become pathogenic for highly vulnerable patients.
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Sources and reservoirs of Staphylococcus Capitis NRCS-A inside a NICU.
Antimicrobial resistance and infection control, 2019Co-Authors: Marine Butin, J. C. Picaud, Yann Dumont, Patricia Martins Simoes, Alice Monteix, Aurane Raphard, Christine Roques, Frédéric LaurentAbstract:The methicillin-resistant clone Staphylococcus Capitis NRCS-A, involved in sepsis in neonatal intensive care units (NICUs) worldwide, is able to persist and spread in NICUs, suggesting the presence of reservoirs inside each setting. The purpose of the present study was to identify these reservoirs and to investigate the cycle of transmission of NRCS-A in one NICU. In a single institution study, NRCS-A was sought in 106 consecutive vaginal samples of pregnant women to identify a potential source of NRCS-A importation into the NICU. Additionally NICU caregivers and environmental including incubators were tested to identify putative secondary reservoirs. Finally, the efficacy of disinfection procedure in the elimination of NRCS-A from incubators was evaluated. No S. Capitis was isolated from vaginal samples of pregnant women. Three of the 21 tested caregivers (14%) carried S. Capitis on their hands, but none remain positive after a five-day wash-out period outside NICU. Moreover, the clone NRCS-A persisted during six consecutive weeks in the NICU environment, but none of the sampled sites was constantly contaminated. Finally in our before/after disinfection study, all of 16 incubators were colonized before disinfection and 10 (62%) incubators remained colonized with NRCS-A after the disinfection procedure. The partial ineffectiveness of incubators’ disinfection procedures is responsible for persistence of NRCS-A inside a NICU, and the passive hand contamination of caregivers could be involved in the inter-patient transmission of S. Capitis.
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Sources and reservoirs of Staphylococcus Capitis NRCS-A inside a NICU
Antimicrobial Resistance and Infection Control, 2019Co-Authors: Marine Butin, J. C. Picaud, Yann Dumont, Patricia Martins Simoes, Alice Monteix, Aurane Raphard, Christine Roques, Frédéric LaurentAbstract:Background: The methicillin-resistant clone Staphylococcus Capitis NRCS-A, involved in sepsis in neonatal intensive care units (NICUs) worldwide, is able to persist and spread in NICUs, suggesting the presence of reservoirs inside each setting. The purpose of the present study was to identify these reservoirs and to investigate the cycle of transmission of NRCS-A in one NICU. Methods: In a single institution study, NRCS-A was sought in 106 consecutive vaginal samples of pregnant women to identify a potential source of NRCS-A importation into the NICU. Additionally NICU caregivers and environmental including incubators were tested to identify putative secondary reservoirs. Finally, the efficacy of disinfection procedure in the elimination of NRCS-A from incubators was evaluated. Results: No S. Capitis was isolated from vaginal samples of pregnant women. Three of the 21 tested caregivers (14%) carried S. Capitis on their hands, but none remain positive after a five-day wash-out period outside NICU. Moreover, the clone NRCS-A persisted during six consecutive weeks in the NICU environment, but none of the sampled sites was constantly contaminated. Finally in our before/after disinfection study, all of 16 incubators were colonized before disinfection and 10 (62%) incubators remained colonized with NRCS-A after the disinfection procedure. Conclusions: The partial ineffectiveness of incubators' disinfection procedures is responsible for persistence of NRCS-A inside a NICU, and the passive hand contamination of caregivers could be involved in the inter-patient transmission of S. Capitis.
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Chromogenic detection procedure for the multidrug-resistant, neonatal sepsis-associated clone Staphylococcus Capitis NRCS-A
Diagnostic Microbiology and Infectious Disease, 2018Co-Authors: Marine Butin, Patricia Martins Simões, Jean-philippe Rasigade, J. C. Picaud, Yann Dumont, Louise Hoden, Frédéric LaurentAbstract:The multiresistant Staphylococcus Capitis clone NRCS-A is a major pathogen in neonates worldwide. We show that NRCS-A grows as mauve colonies with a cream-color halo after a 5-day incubation on MRSA Brilliance 2 agar (Oxoid\textregistered). This innovative protocol will ease the screening of clinical and environmental niches of this clone.
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Vancomycin treatment is a risk factor for vancomycin-nonsusceptible Staphylococcus Capitis sepsis in preterm neonates
Clinical Microbiology and Infection, 2017Co-Authors: Marine Butin, Patricia Martins Simões, Jean-philippe Rasigade, J. C. Picaud, François Vandenesch, F. Subtil, C. Pralong, Anne-marie Freydière, Sylvestre Tigaud, Frédéric LaurentAbstract:OBJECTIVES: Multidrug-resistant, vancomycin-nonsusceptible Staphylococcus Capitis is an emerging cause worldwide of late-onset sepsis (LOS) in preterm neonates. The pathophysiology and risk factors for S.~Capitis-related LOS are poorly understood, but we hypothesized that S.~Capitis LOS follows translocation from the gut microbiota rather than catheter invasion. The objective of this study was to investigate the risk factors of S.~Capitis LOS and gut colonization. METHODS: We conducted a prospective single-centre cohort study of patients hospitalized in a tertiary-care unit (Lyon, France) from June 2011 to January 2012. S.~Capitis gut colonization was determined weekly from stool cultures. The determinants of gut colonization and LOS were established by multivariate Cox proportional hazards models. RESULTS: Eighty-three (36.2%) of 229 patients had S.~Capitis-positive stool culture, and 28 (12.2%) developed S.~Capitis LOS during hospitalization. Independent risk factors for S.~Capitis LOS included prior administration of vancomycin independent of a previous LOS episode (hazard ratio 6.44, 95% confidence interval 2.15-19.3, p 0.001) and low birth weight (hazard ratio 0.72 per 100~g increase, 95% confidence interval 0.55-0.95, p 0.02). The prior administration of vancomycin was also an independent risk factor for S.~Capitis colonization (hazard ratio 3.45, 95% confidence interval 2.07-5.76, p \textless0.001), particularly in the first week of life and in noncolonized neonates. CONCLUSIONS: Neonates treated with vancomycin are at a higher risk of LOS caused by vancomycin-nonsusceptible S.~Capitis. The use of vancomycin in neonates must urgently be optimized to limit the selection of vancomycin-nonsusceptible strains, for which alternative antibiotics are lacking.
Patricia Martins Simões - One of the best experts on this subject based on the ideXlab platform.
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Niche specialization and spread of Staphylococcus Capitis involved in neonatal sepsis
Nature Microbiology, 2020Co-Authors: Thierry Wirth, Patricia Martins Simões, Jean-philippe Rasigade, Marine Bergot, Bruno Pichon, Maxime Barbier, Laurent Jacob, Rachel Pike, Pierre Tissieres, J. C. PicaudAbstract:The multidrug-resistant Staphylococcus Capitis NRCS-A clone is responsible for sepsis in preterm infants in neonatal intensive care units (NICUs) worldwide. Here, to retrace the spread of this clone and to identify drivers of its specific success, we investigated a representative collection of 250 S. Capitis isolates from adults and newborns. Bayesian analyses confirmed the spread of the NRCS-A clone and enabled us to date its emergence in the late 1960s and its expansion during the 1980s, coinciding with the establishment of NICUs and the increasing use of vancomycin in these units, respectively. This dynamic was accompanied by the acquisition of mutations in antimicrobial resistance- and bacteriocin-encoding genes. Furthermore, combined statistical tools and a genome-wide association study convergently point to vancomycin resistance as a major driver of NRCS-A success. We also identified another S. Capitis subclade (alpha clade) that emerged independently, showing parallel evolution towards NICU specialization and non-susceptibility to vancomycin, indicating convergent evolution in NICU-associated pathogens. These findings illustrate how the broad use of antibiotics can repeatedly lead initially commensal drug-susceptible bacteria to evolve into multidrug-resistant clones that are able to successfully spread worldwide and become pathogenic for highly vulnerable patients.
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Chromogenic detection procedure for the multidrug-resistant, neonatal sepsis-associated clone Staphylococcus Capitis NRCS-A
Diagnostic Microbiology and Infectious Disease, 2018Co-Authors: Marine Butin, Patricia Martins Simões, Jean-philippe Rasigade, J. C. Picaud, Yann Dumont, Louise Hoden, Frédéric LaurentAbstract:The multiresistant Staphylococcus Capitis clone NRCS-A is a major pathogen in neonates worldwide. We show that NRCS-A grows as mauve colonies with a cream-color halo after a 5-day incubation on MRSA Brilliance 2 agar (Oxoid\textregistered). This innovative protocol will ease the screening of clinical and environmental niches of this clone.
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Vancomycin treatment is a risk factor for vancomycin-nonsusceptible Staphylococcus Capitis sepsis in preterm neonates
Clinical Microbiology and Infection, 2017Co-Authors: Marine Butin, Patricia Martins Simões, Jean-philippe Rasigade, J. C. Picaud, François Vandenesch, F. Subtil, C. Pralong, Anne-marie Freydière, Sylvestre Tigaud, Frédéric LaurentAbstract:OBJECTIVES: Multidrug-resistant, vancomycin-nonsusceptible Staphylococcus Capitis is an emerging cause worldwide of late-onset sepsis (LOS) in preterm neonates. The pathophysiology and risk factors for S.~Capitis-related LOS are poorly understood, but we hypothesized that S.~Capitis LOS follows translocation from the gut microbiota rather than catheter invasion. The objective of this study was to investigate the risk factors of S.~Capitis LOS and gut colonization. METHODS: We conducted a prospective single-centre cohort study of patients hospitalized in a tertiary-care unit (Lyon, France) from June 2011 to January 2012. S.~Capitis gut colonization was determined weekly from stool cultures. The determinants of gut colonization and LOS were established by multivariate Cox proportional hazards models. RESULTS: Eighty-three (36.2%) of 229 patients had S.~Capitis-positive stool culture, and 28 (12.2%) developed S.~Capitis LOS during hospitalization. Independent risk factors for S.~Capitis LOS included prior administration of vancomycin independent of a previous LOS episode (hazard ratio 6.44, 95% confidence interval 2.15-19.3, p 0.001) and low birth weight (hazard ratio 0.72 per 100~g increase, 95% confidence interval 0.55-0.95, p 0.02). The prior administration of vancomycin was also an independent risk factor for S.~Capitis colonization (hazard ratio 3.45, 95% confidence interval 2.07-5.76, p \textless0.001), particularly in the first week of life and in noncolonized neonates. CONCLUSIONS: Neonates treated with vancomycin are at a higher risk of LOS caused by vancomycin-nonsusceptible S.~Capitis. The use of vancomycin in neonates must urgently be optimized to limit the selection of vancomycin-nonsusceptible strains, for which alternative antibiotics are lacking.
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Emergence and dissemination of a linezolid-resistant Staphylococcus Capitis clone in Europe
The Journal of antimicrobial chemotherapy, 2017Co-Authors: Marine Butin, Patricia Martins Simões, Bruno Pichon, D. Leyssene, S. Bordes-couecou, Hélène Meugnier, C. Rouard, Nadine Lemaître, F. Schramm, Angela KearnsAbstract:Objectives We investigated the epidemiological, clinical, microbiological and genetic characteristics of linezolid-resistant (LZR) Staphylococcus Capitis isolates from French ICUs, and compared them with LZR S. Capitis isolates from other European countries. Methods All LZR isolates were subjected to antimicrobial susceptibility testing (AST) and the presence of cfr and optrA genes as well as mutations in the 23S rRNA and ribosomal proteins were investigated using specific PCR with sequencing. The genetic relationship between isolates was investigated using PFGE and WGS. Epidemiological data concerning LZR S. Capitis were collected retrospectively in French microbiology laboratories. Results Twenty-one LZR isolates were studied: 9 from France, 11 from Greece and 1 from Finland. All were resistant to methicillin and aminoglycosides. In addition, this unusual AST profile was identified in S. Capitis isolates from seven French hospitals, and represented up to 12% of the S. Capitis isolates in one centre. A G2576T mutation in 23S rRNA was identified in all isolates; cfr and optrA genes were absent. All isolates belonged to the same clone on the basis of their PFGE profiles, whatever their geographical origin. WGS found at most 212 SNPs between core genomes of the LZR isolates. Conclusions We identified and characterized an LZR S. Capitis clone disseminated in three European countries, harbouring the same multiple resistance and a G2576T mutation in the 23S rRNA. The possible unrecognized wider distribution of this clone, belonging to a species classically regarded as a low-virulence skin colonizer, is of major concern not least because of the increasing use of oxazolidinones.
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Vancomycin treatment is a risk factor for vancomycin-nonsusceptible Staphylococcus Capitis sepsis in preterm neonates
Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases, 2017Co-Authors: Marine Butin, Patricia Martins Simões, Jean-philippe Rasigade, J. C. Picaud, François Vandenesch, F. Subtil, C. Pralong, Anne-marie Freydière, Sylvestre Tigaud, Frédéric LaurentAbstract:Abstract Objectives Multidrug-resistant, vancomycin-nonsusceptible Staphylococcus Capitis is an emerging cause worldwide of late-onset sepsis (LOS) in preterm neonates. The pathophysiology and risk factors for S. Capitis –related LOS are poorly understood, but we hypothesized that S. Capitis LOS follows translocation from the gut microbiota rather than catheter invasion. The objective of this study was to investigate the risk factors of S. Capitis LOS and gut colonization. Methods We conducted a prospective single-centre cohort study of patients hospitalized in a tertiary-care unit (Lyon, France) from June 2011 to January 2012. S. Capitis gut colonization was determined weekly from stool cultures. The determinants of gut colonization and LOS were established by multivariate Cox proportional hazards models. Results Eighty-three (36.2%) of 229 patients had S. Capitis –positive stool culture, and 28 (12.2%) developed S. Capitis LOS during hospitalization. Independent risk factors for S. Capitis LOS included prior administration of vancomycin independent of a previous LOS episode (hazard ratio 6.44, 95% confidence interval 2.15–19.3, p 0.001) and low birth weight (hazard ratio 0.72 per 100 g increase, 95% confidence interval 0.55–0.95, p 0.02). The prior administration of vancomycin was also an independent risk factor for S. Capitis colonization (hazard ratio 3.45, 95% confidence interval 2.07–5.76, p Conclusions Neonates treated with vancomycin are at a higher risk of LOS caused by vancomycin-nonsusceptible S. Capitis. The use of vancomycin in neonates must urgently be optimized to limit the selection of vancomycin-nonsusceptible strains, for which alternative antibiotics are lacking.