B Strommenger

Publications of B Strommenger

• Community-associated methicillin-resistant Staphylococcus aureus ST8 ("USA300") in an HIV-positive patient in Cologne, Germany, February 2008.

  Authors: W Witte, C Braulke, B Strommenger

  Euro surveillance : bulletin européen sur les maladies transmissibles = European communicable disease bulletin. 04/2008; 13(13).

• Multiplex PCR for rapid detection of Staphylococcus aureus isolates suspected to represent community-acquired strains.

  Authors: B Strommenger, C Braulke, B Pasemann, C Schmidt, W Witte

  Journal of clinical microbiology. 03/2008; 46(2):582-7.

  The continuous spread of community-acquired methicillin-resistant Staphylococcus aureus (caMRSA) and the introduction of these highly virulent isolates into hospitals represent increasing threats.The continuous spread of community-acquired methicillin-resistant Staphylococcus aureus (caMRSA) and the introduction of these highly virulent isolates into hospitals represent increasing threats. The timely recognition of caMRSA strains is crucial for infection control purposes. Thus, we developed a PCR-based assay for the easy and rapid determination of those caMRSA clones that currently are the most prevalent in Germany and Central Europe. This assay was able to correctly identify the majority of the isolates as caMRSA of sequence type 80 (ST80), clonal complex 1 (USA400), and ST8 (USA300). In combination with spa typing-BURP (based upon repeat pattern) analysis and resistance typing, it provides a means for the extensive characterization of suspicious isolates. Thus, this assay represents a reliable tool for monitoring the emergence and spread of different caMRSA clones. The resulting information, in combination with careful interpretation of the epidemiological records, might help to prevent the further spread of those highly virulent caMRSA clones.

• spa Typing of Staphylococcus aureus as a frontline tool in epidemiological typing.

  Authors: B Strommenger, C Braulke, D Heuck, C Schmidt, B Pasemann, U Nübel, W Witte

  Journal of clinical microbiology. 03/2008; 46(2):574-81.

  We determined the value of spa typing in combination with BURP (based upon repeat pattern) grouping analysis as a frontline tool in the epidemiological typing of Staphylococcus aureus, based on aWe determined the value of spa typing in combination with BURP (based upon repeat pattern) grouping analysis as a frontline tool in the epidemiological typing of Staphylococcus aureus, based on a random collection of 1,459 clinical isolates sent to the German Reference Centre for Staphylococci within a 6-month period. The application was found to be helpful for the classification of isolates into the particular clonal lineages currently prevalent in Germany. Due to its major advantages because of the ease of interpretation and the exchangeability of the results, the use of spa typing greatly simplifies communication between laboratories on both the national and the international levels. Thus, it is an excellent tool for national and international surveillance of S. aureus as well as for analysis of the short-term local epidemiology. However, to overcome the limitations of the BURP grouping method in terms of typing accuracy and discriminatory power, the results of the default BURP grouping method must be interpreted with caution. Additional markers, like staphylococcal chromosomal cassette mec, lineage-specific genes, or alternative DNA polymorphisms, are indispensable. They should be selected by dependence on the clonal lineage indicated by spa typing and subsequent BURP analysis as well as on the basis of the particular question to be addressed.

• Meticillin-resistant Staphylococcus aureus: occurrence of a new spa type in two acute care hospitals in Austria.

  Authors: W Ruppitsch, A Stöger, O Braun, B Strommenger, U Nübel, G Wewalka, F Allerberger

  The Journal of hospital infection. 01/2008; 67(4):316-22.

  Typing multiply-resistant bacteria using molecular techniques is high priority for national health authorities. Routine typing of meticillin-resistant Staphylococcus aureus (MRSA) was initiated inTyping multiply-resistant bacteria using molecular techniques is high priority for national health authorities. Routine typing of meticillin-resistant Staphylococcus aureus (MRSA) was initiated in Austria 2005 and was performed by sequence analysis of the variable X region of protein A gene (spa), characterisation of the mec gene (SCCmec) and testing for Panton-Valentine leukocidin (PVL), enterotoxins, toxic shock syndrome toxin and the epidermolytic toxin genes. Ten different spa types, including newly identified t2023, were found among 66 clinical MRSA isolates originating from two neighbouring hospitals under the same management. Spa type t2023 was initially isolated in December 2005 from hospital A, where it became the dominant spa type during 2006 (nine of 16 isolates). The occurrence of type t2023 in hospital B remained a unique event and could be epidemiologically linked to a patient transferred from hospital A. Spa type t2023 is very similar to spa type t001. An isolate of spa type t001 from hospital A showed an enterotoxin gene pattern, multilocus sequence type (MLST) and SmaI macrorestriction PFGE pattern indistinguishable from that of t2023. Epidemiological differences suggested that infection control measures can prevent MRSA cross-transmission. Hospital B had a more stringent MRSA isolation policy, a higher nurse:patient ratio and provided more resources for infection control than hospital A.

• Clonal distribution of superantigen genes in clinical Staphylococcus aureus isolates.

  Authors: S Holtfreter, D Grumann, M Schmudde, H T T Nguyen, P Eichler, B Strommenger, K Kopron, J Kolata, S Giedrys-Kalemba, I Steinmetz, W Witte, B M Bröker

  Journal of clinical microbiology. 09/2007; 45(8):2669-80.

  Staphylococcus aureus is both a successful human commensal and a major pathogen. The elucidation of the molecular determinants of virulence, in particular assessment of the contributions of theStaphylococcus aureus is both a successful human commensal and a major pathogen. The elucidation of the molecular determinants of virulence, in particular assessment of the contributions of the genetic background versus those of mobile genetic elements (MGEs), has proved difficult in this variable species. To address this, we simultaneously determined the genetic backgrounds (spa typing) and the distributions of all 19 known superantigens and the exfoliative toxins A and D (multiplex PCR) as markers for MGEs. Methicillin- sensitive S. aureus strains from Pomerania, 107 nasal and 88 blood culture isolates, were investigated. All superantigen-encoding MGEs were linked more or less tightly to the genetic background. Thus, each S. aureus clonal complex was characterized by a typical repertoire of superantigen and exfoliative toxin genes. However, within each S. aureus clonal complex and even within the same spa type, virulence gene profiles varied remarkably. Therefore, virulence genes of nasal and blood culture isolates were separately compared in each clonal complex. The results indicated a role in infection for the MGE harboring the exfoliative toxin D gene. In contrast, there was no association of superantigen genes with bloodstream invasion. In summary, we show here that the simultaneous assessment of virulence gene profiles and the genetic background increases the discriminatory power of genetic investigations into the mechanisms of S. aureus pathogenesis.

• Assignment of Staphylococcus isolates to groups by spa typing, SmaI macrorestriction analysis, and multilocus sequence typing.

  Authors: B Strommenger, C Kettlitz, T Weniger, D Harmsen, A W Friedrich, W Witte

  Journal of clinical microbiology. 08/2006; 44(7):2533-40.

  The implementation of the new clustering algorithm Based Upon Repeat Pattern (BURP) into the Ridom StaphType software tool enables clustering based on spa typing data for Staphylococcus aureus. WeThe implementation of the new clustering algorithm Based Upon Repeat Pattern (BURP) into the Ridom StaphType software tool enables clustering based on spa typing data for Staphylococcus aureus. We compared clustering results obtained by spa typing/BURP to those obtained by currently well-established methods, i.e., SmaI macrorestriction analysis and multilocus sequence typing/eBURST. A total of 99 clinical S. aureus strains, including MRSA and representing major clonal lineages associated with important kinds of infections which have been prevalent in Germany and Central Europe during the last 10 years, were used for comparison. SmaI macrorestriction analysis revealed the highest discriminatory power, and clustering results for all three methods resulted in concordance values ranging from 96.8% between the two sequence-based methods to 93.4% between spa typing/BURP and SmaI macrorestriction/cluster analysis. The results of this study indicate that spa typing, together with BURP clustering, is a useful tool in S. aureus epidemiology, especially because of ease of use and the advantages of unambiguous sequence analysis as well as reproducibility and exchange of typing data.

• Characterization of methicillin-resistant Staphylococcus aureus from Ulaanbaatar, Mongolia.

  Authors: D Orth, K Grif, L Erdenechimeg, C Battogtokh, T Hosbayar, B Strommenger, C Cuny, G Walder, C Lass-Flörl, M P Dierich, W Witte

  European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology. 03/2006; 25(2):104-7.

  In order to expand current knowledge of the types of methicillin-resistant Staphylococcus aureus (MRSA) strains circulating in central Asia, six MRSA strains collected from hospitals in Ulaanbaatar,In order to expand current knowledge of the types of methicillin-resistant Staphylococcus aureus (MRSA) strains circulating in central Asia, six MRSA strains collected from hospitals in Ulaanbaatar, Mongolia during 2000-2002 were examined. Three strains possessed a staphylococcal cassette chromosome mec (SCCmec) element of type IV c, were sequence type (ST) 154 according to multilocus sequence typing (MLST), and contained lukS-lukF (Panton-Valentine leukocidin). Another three strains contained a SCCmec element of type III and were MLST type ST 239. Using automated ribotyping, the six MRSA strains were divided into four different EcoRI ribotypes, and two groups of isolates were distinguished by means of SmaI-macrorestriction patterns. In comparison to other countries, the incidence of MRSA in Mongolia is low.

• High interlaboratory reproducibility of DNA sequence-based typing of bacteria in a multicenter study.

  Authors: M Aires de Sousa, K Boye, H de Lencastre, A Deplano, M C Enright, J Etienne, A Friedrich, D Harmsen, A Holmes, X.W. Huijsdens [......] J K Rasheed, E. Spalburg, B Strommenger, M J Struelens, F C Tenover, J Thomas, U Vogel, H Westh, J Xu, W Witte

  Journal of clinical microbiology. 03/2006; 44(2):619-21.

  Current DNA amplification-based typing methods for bacterial pathogens often lack interlaboratory reproducibility. In this international study, DNA sequence-based typing of the Staphylococcus aureusCurrent DNA amplification-based typing methods for bacterial pathogens often lack interlaboratory reproducibility. In this international study, DNA sequence-based typing of the Staphylococcus aureus protein A gene (spa, 110 to 422 bp) showed 100% intra- and interlaboratory reproducibility without extensive harmonization of protocols for 30 blind-coded S. aureus DNA samples sent to 10 laboratories. Specialized software for automated sequence analysis ensured a common typing nomenclature.

• Emergence of MRSA infections in horses in a veterinary hospital: strain characterisation and comparison with MRSA from humans.

  Authors: C Cuny, J Kuemmerle, C Stanek, B Willey, B Strommenger, W Witte

  Euro surveillance : bulletin européen sur les maladies transmissibles = European communicable disease bulletin. 02/2006; 11(1):44-7.

  Methicillin-resistant Staphylococcus aureus has become an emerging public health problem worldwide, no longer only associated with healthcare-associated infections. With the exception of some recentMethicillin-resistant Staphylococcus aureus has become an emerging public health problem worldwide, no longer only associated with healthcare-associated infections. With the exception of some recent reports concerning infections in cats, dogs and horses, infections with MRSA in companion animals have been infrequently reported. Here we submit findings for MRSA infections in horses in a central European university hospital.

• High interlaboratory reproducibility of DNA sequence-based typing of bacteria in a multicenter study

  Authors: M. ires-de-Sousa, K. Boye, Lencastre H. de, A. Deplano, M.C. Enright, J. Etienne, A. Friedrich, D. Harmsen, A. Holmes, X.W. Huijsdens [......] J.K. Rasheed, E. Spalburg, B. Strommenger, M.J. Struelens, F.C. Tenover, J. Thomas, U. Vogel, H. Westh, J. Xu, W. Witte

  J.Clin.Microbiol. 02/2006; 44.

  Current DNA amplification-based typing methods for bacterial pathogens often lack interlaboratory reproducibility. In this international study, DNA sequence-based typing of the Staphylococcus aureusCurrent DNA amplification-based typing methods for bacterial pathogens often lack interlaboratory reproducibility. In this international study, DNA sequence-based typing of the Staphylococcus aureus protein A gene (spa, 110 to 422 bp) showed 100% intra- and interlaboratory reproducibility without extensive harmonization of protocols for 30 blind-coded S. aureus DNA samples sent to 10 laboratories. Specialized software for automated sequence analysis ensured a common typing nomenclature

• Spread of ampicillin/vancomycin-resistant Enterococcus faecium of the epidemic-virulent clonal complex-17 carrying the genes esp and hyl in German hospitals.

  Authors: I Klare, C Konstabel, S Mueller-Bertling, G Werner, B Strommenger, C Kettlitz, S Borgmann, B Schulte, D Jonas, A Serr, A M Fahr, U Eigner, W Witte

  European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology. 01/2006; 24(12):815-25.

  The incidence of vancomycin-resistant Enterococcus faecium isolation was low (<or=5%) in German hospitals before 2003. Within the second half of 2003 and the first half of 2004, however, increasingThe incidence of vancomycin-resistant Enterococcus faecium isolation was low (<or=5%) in German hospitals before 2003. Within the second half of 2003 and the first half of 2004, however, increasing frequencies of up to 14% were noticed in several hospitals in southwestern Germany. This increase was attributed mainly to the occurrence and spread of epidemic-virulent ampicillin/vancomycin-resistant, vanA- and vanB-positive E. faecium clones, most of which exhibited the virulence factors enterococcal surface protein (esp) and bacteriocin activity and some which exhibited hyaluronidase (hyl). E. faecium possessing hyaluronidase was initially found in U.S. hospitals and recently detected in several European hospitals and, subsequently, in German hospitals as well. Ampicillin/vancomycin-resistant E. faecium clones originating mainly from southwestern German hospitals were characterized by multilocus sequence typing since different sequence types (STs) belonging to the clonal complex-17 are currently disseminated worldwide. Multilocus sequence typing revealed that, in 1998 and 1999, ampicillin/vancomycin-resistant E. faecium clone ST-117 was prevalent in various German hospitals, while in 2003 and 2004, clone ST-203 dominated in several hospitals located in southwestern Germany. Both sequence types display single-locus variants of ST-78, which was frequently recorded in various Italian hospitals between 2000 and 2003, and all of these STs belong to the clonal complex-17. Expression of linezolid resistance was observed in ampicillin/glycopeptide-resistant E. faecium strains (VanA type) from two tertiary hospitals in southwestern Germany due to mutations in domain V of the 23S rDNA (G2576T). While in one hospital the resistance emerged during linezolid therapy, in the other hospital resistance was caused by transfer of an identical linezolid/ampicillin/glycopeptide-resistant E. faecium strain. In conclusion, it is very important to monitor the occurrence of epidemic-virulent clonal complex-17 strains of E. faecium to prevent their spread in hospitals, especially if they are resistant to glycopeptides and linezolid.

• New strains of community-acquired methicillin-resistant Staphylococcus aureus with Panton-Valentine leukocidin causing an outbreak of severe soft tissue infection in a football team.

  Authors: M Müller-Premru, B Strommenger, N Alikadic, W Witte, A W Friedrich, K Seme, N Svent Kucina, D Smrke, V Spik, M Gubina

  European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology. 01/2006; 24(12):848-50.

• Healthcare-associated outbreaks and community-acquired infections due to MRSA carrying the Panton-Valentine leucocidin gene in southeastern Germany.

  Authors: H Linde, F Wagenlehner, B Strommenger, I Drubel, J Tanzer, U Reischl, U Raab, C Höller, K G Naber, W Witte, F Hanses, B Salzberger, N Lehn

  European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology. 07/2005; 24(6):419-22.

  In response to several isolations of methicillin-resistant Staphylococcus aureus carrying the Panton-Valentine leucocidin gene (PVL-MRSA), the present study was conducted to document the spread ofIn response to several isolations of methicillin-resistant Staphylococcus aureus carrying the Panton-Valentine leucocidin gene (PVL-MRSA), the present study was conducted to document the spread of infection in a small region of southeastern Germany. During a 9-month period, two healthcare-associated outbreaks with PVL-MRSA occurred, affecting 83 patients, personnel and contacts of personnel, and 34 additional cases were detected in the community. The clinical spectrum ranged from colonization to skin infection and necrotizing pneumonia. The findings represent the largest number of PVL-MRSA cases detected in Germany so far, and demonstrate the potential of this emerging pathogen to spread within the community and in healthcare institutions.

• Emergence of methicillin-resistant Staphylococcus aureus with Panton-Valentine leukocidin genes in central Europe.

  Authors: W Witte, C Braulke, C Cuny, B Strommenger, G Werner, D Heuck, U Jappe, C Wendt, H J Linde, D Harmsen

  European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology. 02/2005; 24(1):1-5.

  The aim of the present study was to investigate strains of methicillin-resistant Staphylococcus aureus (MRSA) for the presence of the lukS-lukF determinant of Panton-Valentine leukocidin and toThe aim of the present study was to investigate strains of methicillin-resistant Staphylococcus aureus (MRSA) for the presence of the lukS-lukF determinant of Panton-Valentine leukocidin and to further characterize strains found to contain the genes. During the past 2 years, MRSA containing the lukS-lukF genes for Panton-Valentine leukocidin, particularly those emerging outside of hospitals, have become of interest. MRSA strains sent to the national reference center in Germany were investigated for lukS-lukF by polymerase chain reaction (PCR). If the presence of lukS-lukF was demonstrated, strains were further characterized by molecular typing (determination of SmaI pattern, spa sequence, and multilocus sequence type), PCR demonstration of resistance genes, and characterization of the SCCmec element. Since the end of 2002, MRSA containing Panton-Valentine leukocidin genes have been demonstrated as the causative agent of 28 cases of infection (9 community-acquired cases, 19 sporadic nosocomial cases) in different areas of Germany. Twenty-seven of these 28 isolates exhibited a unique pattern of genomic typing: all exhibited multilocus sequence type 80, spa sequence type 44, and a SmaI macrorestriction pattern that corresponds to a community-acquired strain of MRSA from France and Switzerland. In addition to resistance to oxacillin, the strains exhibited resistance to ciprofloxacin, tetracycline (tetM), and fusidic acid, the last of which is encoded by the far-1 gene. The far-1 gene was shown to be located on the plasmid. One isolate corresponded to community MRSA (cMRSA) of multilocus sequence type 1 from the USA.

• [Antibiotic-resistant nosocomial pathogens. Part I: diagnostic and typing methods]

  Authors: W Witte, B Strommenger, I Klare, G Werner

  Bundesgesundheitsblatt, Gesundheitsforschung, Gesundheitsschutz. 05/2004; 47(4):352-62.

  For use in human chemotherapy, there are several different substances for nearly each substance group available which cannot all be checked in routine susceptibility testing. If the bacterialFor use in human chemotherapy, there are several different substances for nearly each substance group available which cannot all be checked in routine susceptibility testing. If the bacterial resistance mechanisms and cross-resistance conferred by them are known, particular test substances can be selected and the results are interpreted on the basis of cross-resistance. Test substances correspond to those mentioned in guidelines for section sign 23 IfSG (German law on protection against infection). Due to suboptimal in vitro expression of different resistance mechanisms, it is necessary to perform additional tests besides routine agar-diffusion or microbroth MIC assays. These are preferentially tests for molecular demonstration of resistance genes. Emergence and spread of antibiotic-resistant nosocomial pathogens can be traced by typing. When selecting a typing method, it is important to assess work load, discriminatory power, and reproducibility. In future the availability of microarray technology will enable routine laboratories to demonstrate particular virulence-associated traits.

• Obvious lack of association between dynamics of epidemic methicillin-resistant Staphylococcus aureus in central Europe and agr specificity groups.

  Authors: B Strommenger, C Cuny, G Werner, W Witte

  European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology. 02/2004; 23(1):15-9.

  During the past 8 years, changes in the prevalence and spread of different epidemic methicillin-resistant Staphylococcus aureus (MRSA) have been observed in central Europe, with the emergence of newDuring the past 8 years, changes in the prevalence and spread of different epidemic methicillin-resistant Staphylococcus aureus (MRSA) have been observed in central Europe, with the emergence of new strains possessing fewer resistance characters. This has also been demonstrated at the level of particular hospitals. Since variation in agr specificity type has been proposed as a possible reason for population dynamics in Staphylococcus aureus, the agr specificity groups of different epidemic MRSA strains were investigated by PCR using agr group-specific primers. Four of the "old" as well as two "new" epidemic strains exhibited agr specificity group I. One group of epidemic MRSA strains, which has been observed since the beginning of the 1990s, exhibited the agr specificity group II. Sequencing the variable part ( agrB-D-C) of the agr locus revealed only six relevant nucleotide changes within this region, with three of them modifying the Shine-Dalgarno sequence region of agrC. On the basis of the results obtained, it is proposed that the dynamics observed in the population of MRSA in Germany is not due to different agr group specificities in "old" and "new" epidemic clones.

• Emergence of a new community acquired MRSA strain in Germany.

  Authors: W Witte, C Cuny, B Strommenger, C Braulke, D Heuck

  Euro surveillance : bulletin européen sur les maladies transmissibles = European communicable disease bulletin. 02/2004; 9(1):16-8.

  Analysis of community-acquired methicillin-resistant Staphylococcus aureus (c-MRSA) from Germany producing the Panton-Valentine leukocidin revealed a unique SmaI-macrorestriction pattern, differentAnalysis of community-acquired methicillin-resistant Staphylococcus aureus (c-MRSA) from Germany producing the Panton-Valentine leukocidin revealed a unique SmaI-macrorestriction pattern, different from epidemic nosocomial strains. This molecular pattern corresponds to those shown in c-MRSA strains from other countries in the European Union. All isolates exhibited resistance to fusidic acid, which is coded by the far-1 gene. From data on geographical dissemination and time of occurrence, this strain appears to have emerged in Germany in the second half of 2002, and so an already wider dissemination is likely. The emergence of MRSA with resistance to fusidic acid is a first sign of the emergence of a PVL-positive MRSA clone.