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Publications (6)11.56 Total impact

  • Diep Ba · Jula M · Perdreau-remington F · Pierre Tattevin · Binh An Diep · Michael Jula · Françoise Perdreau-remington
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    ABSTRACT: We performed a longitudinal analysis of 661 methicillin-resistant Staphylococcus aureus (MRSA) isolates obtained from patients in a long-term care facility. USA300 clone increased from 11.3 % of all MRSA isolates in 2002 to 64.0 % in 2006 (p<0.0001) and was mostly recovered from skin or skin structures (64.3 % vs. 27.0 % for non-USA300 MRSA; p<0.0001). Since 2001, a dramatic increase in methicillin-resistant Staphylococcus aureus (MRSA) infections has been observed in the United States, mostly related to emergence of the USA300 clone in the community (1) and subsequently in hospitals (2,3). Residents of long-term care facilities (LTCFs) are at risk for colonization with antimicrobial drug–resistant bacteria, including MRSA. After they have been colonized, these residents are at increased risk for infections (4). Although it is assumed that transfer of patients between acute-care hospitals and LTCFs provides an ongoing cycle for the introduction of MRSA between these facilities (5), few studies have described the molecular epidemiology of MRSA in LTCFs. We report the prevalence and distribution of MRSA genotypes among clinical isolates obtained over a 10-year period (1997–2006) at the main LTCF in San Francisco, California, USA. Page 1 of 8The Study
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    ABSTRACT: We performed a longitudinal analysis of 661 methicillin-resistant Staphylococcus aureus (MRSA) isolates obtained from patients in a long-term care facility. USA300 clone increased from 11.3% of all MRSA isolates in 2002 to 64.0% in 2006 (p<0.0001) and was mostly recovered from skin or skin structures (64.3% vs. 27.0% for non-USA300 MRSA; p<0.0001).
    Emerging Infectious Diseases 07/2009; 15(6):953-5. DOI:10.3201/eid1506.080195 · 7.33 Impact Factor
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    ABSTRACT: We performed a longitudinal analysis of 502 unique methicillin-resistant Staphylococcus aureus (MRSA) clinical isolates originating from San Francisco jail inmates between 2000 and 2007. Strain USA300, first encountered in 2001, accounted for 82.1% (412/502) of MRSA infections. Non-USA300 MRSA strains were rarely found after 2005 (one isolate in 2006, three in 2007).
    Journal of clinical microbiology 11/2008; 46(12):4056-7. DOI:10.1128/JCM.01372-08 · 4.23 Impact Factor
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    ABSTRACT: Background: Residents of long-term care facilities are at risk for infection with methicillin-resistant Staphylococcus aureus (MRSA). Community-associated MRSA clone USA300 recently emerged as the main pathogen in communities and hospitals in the United States, but little is known about its penetration into long-term care facility. Methods: We performed a longitudinal analysis of 661 non-duplicated clinical MRSA isolates originating from patients treated at a 1000-bed long-term care facility from 1997 to 2006. Isolates were genotyped by pulsed-field gel electrophoresis (PFGE), spa typing and multilocus sequence typing (MLST). Results: The rate of methicillin-resistance among S. aureus increased from 38.1% in 1997 to 72.3% in 2006 (P < .0001). Three PFGE-MLST clonal groups: USA100(ST5), USA300(ST8), andUSA500(ST8), accounted for 85.2% of isolates. From 1997 to 2002, USA100 accounted for 56.2% and USA500 for 16.7% of MRSA isolates. USA300 appeared in 2001, and increased from 11.3% of all MRSA in 2002, to 64.0% in 2006 (P < .0001). Compared to non-USA300, USA300 isolates were more frequently recovered from skin or skin structure samples (64.3% versus 27.0%, P < .0001), and affected younger patients (median 62 years versus 68, P = .001). Conclusions: Community-associated MRSA clone USA300 has emerged as the predominant cause of MRSA disease in this long-term care facility, while the prevalence of the hospital-associated MRSA clone USA100 remained unabated. As a consequence, the rate of methicillin-resistance has almost doubled over 10 years, and MRSA, once primarily isolated from urinary or respiratory tracts, is now mainly encountered in skin or skin structure.
    Infectious Diseases Society of America 2008 Annual Meeting; 10/2008
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    ABSTRACT: Background: Correctional facilities inmates were among the first communities affected by the emergence of USA300 MRSA in the early 2000’s. Thus far, no longitudinal analysis has been performed to describe the long-term evolution of MRSA epidemiology in these settings. Methods: All non-duplicated clinical MRSA isolates obtained between 2000 and 2007 from patients who were inmates of the San Francisco County jail system were genotyped by PFGE and spa typing. USA300 was further defined by the presence of Panton-Valentine leukocidin genes and the arginine catabolic mobile element (ACME) using PCR assays. Only one isolate per patient per year was studied. Results: 494 patients were included. Their median age was 39 years (IQR 32-47), male-to-female ratio was 3.9. Of the 502 MRSA isolates analyzed, 412 (82.1%) were USA300. USA300 appeared in 2001, accounting for 36.4% (8/22) of all MRSA isolates that year. Its incidence peaked at 128/140 isolates (91.4%) in 2004, and then leveled down to ~50 isolates/year. Non USA300 MRSA isolates were rarely found after 2005 (1 isolate in 2006, 3 in 2007). The incidence of methicillin-susceptible S. aureus infections remained unaltered over the study period, with a mean of ~20 isolates per year. MRSA was mostly isolated from skin or skin structure specimen throughout the study period (mean, 92.9% of all specimens). No significant changes in antimicrobial resistance was observed over time for MRSA, with a mean resistance rate at 46.8% for ciprofloxacin, 15.7% for tetracycline, 9.3% for clindamycin, 0.7% for trimethoprim-sulfamethoxazole, and 0.0% for linezolid. Conclusions: Community-associated MRSA clone USA300 is currently endemic in San Francisco jails where it has replaced all previous MRSA clones. It remains primarily associated with skin and skin structure infections, and usually susceptible to trimethoprim-sulfamethoxazole, clindamycin and tetracycline.
    Infectious Diseases Society of America 2008 Annual Meeting; 10/2008
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    ABSTRACT: Background: Epidemic spread of MRSA clone USA300 has led to high burdens of skin and soft tissue infection (SSTI) but its impact on BSI is poorly characterized. Methods: A standardized instrument was used to abstract medical record information from 396 patients with MRSA BSI treated at SF Gen Hosp from 2000 to 2006. PFGE, spa typing and PCR assays were used to characterize MRSA isolates. Results: A dramatic increase in BSI prevalence correlated with epidemic spread of USA300 (figure). Of note, 62% (127/206) of USA300 BSI and 33% (62/190) of non-USA300 BSI were diagnosed in emergency department (ED) (P < 0.001). When compared with non-USA300 BSI, patients with USA300 BSI were more often homeless (56% vs 45%, P = 0.022), IVDU (54% vs 44%, P = 0.047) or HIV positive (25% vs 12%, P = 0.001). Patients with USA300 BSI were also more likely than patients with non-USA300 BSI to have concurrent SSTI (risk ratio = 1.8 [95% CI, 1.3 - 2.3], P < 0.001) or pneumonia (RR = 1.7 [1.1 - 2.6], P = 0.022), but less likely to have surgical site infection (RR = 0.2 [0.1 - 0.7], P = 0.006) or intravascular device infection (RR = 0.5 [0.3 - 0.7], P < 0.001), indicating important changes in the presumed source of BSI. Conclusions: MRSA BSI is now most frequently diagnosed in the ED. Risk factors differ between USA300 and non-USA300 BSI, thereby requiring different approaches to clinical management.
    Infectious Diseases Society of America 2008 Annual Meeting; 10/2008