Christiane Cuny

Robert Koch Institut, Berlín, Berlin, Germany

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Publications (65)187.69 Total impact

  • Christiane Cuny · Lothar Wieler · Wolfgang Witte ·

    11/2015; 4(4):521-543. DOI:10.3390/antibiotics4040521
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    ABSTRACT: Background: While a limited number of studies have investigated the prevalence of methicillin-resistant Staphylococcus aureus (MRSA) in medical rehabilitation institutions, almost no data on the colonization of rehabilitation patients with multiresistant gram-negative rods is available. Here we report on a large multicenter study on the prevalence of MRSA and multiresistant pathogens in rehabilitation institutions in the Rhine-Main area in 2014. Materials and Methods: Altogether, 21 rehabilitation hospitals participated. For all patients, age, gender, previous history of hospitalizations, surgery, previous colonization with multidrug-resistant organisms, use of a medical device, current antimicrobial therapy, and the current infection status were ascertained. On voluntary basis, nare and throat swabs were taken for analysis of MRSA and rectal swabs were tested for extended spectrum betalactamase-producing gram-negative bacteria (ESBL). Results: 50% of 2 440 patients had a history of hospitalization within the previous 6 months while 39% had undergone surgery during the past 30 days. Approximately a quarter of the patients had been transferred to a rehabilitation hospital directly from an acute care hospital, had been under antimicrobial therapy with the past three months, or had travelled to a foreign country within the previous year. Risk factors such as lesions of the intact skin or presence of medical devices were rarely reported (< 5%) within the exception of patients undergoing geriatric or neurologic acute care rehabilitation. 0.7% (15/2155) of the patients were colonized with MRSA, while 7.7% (110/1434) showed a positive result for ESBL. The highest prevalence rates for multiresistant organisms were encountered among patients with neurologic rehabilitation (MRSA, 1.3%, and ESBL, 10.2%) or with geriatric rehabilitation (MRSA, 9.4%, and ESBL, 22.7%). Conclusion: In the rehabilitation patient population, the prevalence rates of MRSA and ESBL were found to be in the range of rates encountered in the general population (reported rates for MRSA, 0.5%, and ESBL, 6.3%). The known risk factors for MRSA such as skin lesions, medical devices and previous history for MRSA were also confirmed among this patient population. Direct transfer from an acute care hospital, antimicrobial treatment during the past 3 months, and wounds proved significant risk factors for ESBL colonization. Patients of neurologic rehabilitation and geriatric patients showed the highest rates of risk factors and the highest prevalence rates of multidrug-resistant organisms. It appears to be of importance for rehabilitation hospitals to be geared to the needs of patients with multidrug-resistant organisms, and prevent the transmission of these pathogens by appropriate hygiene measures.
    Die Rehabilitation 10/2015; 54(5):339-345. DOI:10.1055/s-0035-1559642 · 0.73 Impact Factor
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    Clinical Infectious Diseases 09/2015; DOI:10.1093/cid/civ752 · 8.89 Impact Factor
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    ABSTRACT: Outbreaks of Staphylococcus aureus are common in neonatal intensive care units (NICUs). Usually they are documented for methicillin-resistant strains, while reports involving methicillin-susceptible S. aureus (MSSA) strains are rare. In this study we report the epidemiological and molecular investigation of an MSSA outbreak in a NICU among preterm neonates. Infection control measures and interventions were commissioned by the Local Public Health Authority and supported by the Robert Koch Institute. To support epidemiological investigations molecular typing was done by spa-typing and Multilocus sequence typing; the relatedness of collected isolates was further elucidated by DNA SmaI-macrorestriction, microarray analysis and bacterial whole genome sequencing. A total of 213 neonates, 123 healthcare workers and 205 neonate parents were analyzed in the period November 2011 to November 2012. The outbreak strain was characterized as a MSSA spa-type t021, able to produce toxic shock syndrome toxin-1 and Enterotoxin A. We identified seventeen neonates (of which two died from toxic shock syndrome), four healthcare workers and three parents putatively involved in the outbreak. Whole-genome sequencing permitted to exclude unrelated cases from the outbreak and to discuss the role of healthcare workers as a reservoir of S. aureus on the NICU. Genome comparisons also indicated the presence of the respective clone on the ward months before the first colonized/infected neonates were detected. Copyright © 2015. Published by Elsevier GmbH.
    International journal of medical microbiology: IJMM 08/2015; DOI:10.1016/j.ijmm.2015.08.033 · 3.61 Impact Factor
  • M Hogardt · P Proba · D Mischler · C Cuny · V A Kempf · U Heudorf ·
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    ABSTRACT: Multidrug-resistant organisms (MDRO) and in particular multidrug-resistant Gram-negative organisms (MRGN) are an increasing problem in hospital care. However, data on the current prevalence of MDRO in long-term care facilities (LTCFs) are rare. To assess carriage rates of MDRO in LTCF residents in the German Rhine-Main region, we performed a point prevalence survey in 2013. Swabs from nose, throat and perineum were analysed for meticillin-resistant Staphylococcus aureus (MRSA), perianal swabs were analysed for extended-spectrum beta-lactamase (ESBL)-producing organisms, MRGN and vancomycin-resistant enterococci (VRE). In 26 LTCFs, 690 residents were enrolled for analysis of MRSA colonisation and 455 for analysis of rectal carriage of ESBL/MRGN and VRE. Prevalences for MRSA, ESBL/MRGN and VRE were 6.5%, 17.8%, and 0.4%, respectively. MRSA carriage was significantly associated with MRSA history, the presence of urinary catheters, percutaneous endoscopic gastrostomy tubes and previous antibiotic therapy, whereas ESBL/MRGN carriage was exclusively associated with urinary catheters. In conclusion, this study revealed no increase in MRSA prevalence in LTCFs since 2007. In contrast, the rate of ESBL/MRGN carriage in German LTCFs was remarkably high. In nearly all positive residents, MDRO carriage had not been known before, indicating a lack of screening efforts and/or a lack of information on hospital discharge. © 2015, European Centre for Disease Prevention and Control (ECDC). All Rights Reserved.
    Eurosurveillance: bulletin europeen sur les maladies transmissibles = European communicable disease bulletin 07/2015; 20(26). DOI:10.2807/1560-7917.ES2015.20.26.21171 · 5.72 Impact Factor
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    ABSTRACT: The immune evasion gene cluster (IEC) is typical for Staphylococcus aureus isolated from humans but is usually absent in S. aureus isolated from animals. Previous studies have shown that methicillin resistant S. aureus (MRSA) CC398 obviously lost the IEC when evolving as livestock-associated MRSA from a human-adapted, methicillin-susceptible ancestor. This study aimed to look for the presence of IEC in MRSA from pigs and horses as well as from the colonization of humans with occupational animal contact and from infections in humans. For comparison, methicillin susceptible S. aureus (MSSA) isolates from infections in humans were included.
    Veterinary Microbiology 03/2015; 177(1-2). DOI:10.1016/j.vetmic.2015.02.031 · 2.51 Impact Factor
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    ABSTRACT: Methicillin-resistant Staphylococcus aureus (MRSA) is a major cause of bacteraemia. We aimed for a complete picture of severe MRSA infections by characterizing all MRSA isolates from bloodstream infections in the largest German federal state (North Rhine-Westphalia, 18 million inhabitants) using S. aureus protein A (spa) sequence-typing and antimicrobial susceptibility testing. MRSA isolates (n=1,952) were prospectively (2011-2013) collected and spa-typed. Among 181 different spa types, t003 (n=746 isolates; 38.2%) and t032 (n=594; 30.4%) were predominant. Analysis of the geographical occurrence of spa clonal complexes (spa-CCs) and spa types revealed divergent distribution between federal state districts for spa-CCs 003 (p<0.001; including t003, p<0.001 and t264, p<0.001), 008 (p=0.021), 011 (p=0.002), 032 (p<0.001; including t022, p=0.014 and t032, p<0.001) and spa type t2807 (p<0.001).Minimum inhibitory concentrations (MICs) of antimicrobial substances were tested using broth microdilution. Of all isolates, 96% were resistant to fluoroquinolons, 78% to erythromycin, 70% to clindamycin, 4% to gentamicin, 2% to rifampicin, 0.4% to daptomycin, 0.1% to linezolid and 0% to vancomycin, respectively. Vancomycin MICs of 2 mg/L involved 0.5% of the isolates. In conclusion, the detection of regional molecular clusters added valuable information for epidemiological case tracing and allowed for conclusions on the importance of newly emerging MRSA reservoirs, such as livestock (spa-CC011), for MRSA bacteraemia in some parts of the federal state. Susceptibility testing revealed broad resistance to substances used for oral treatment, but demonstrated that those antibiotics that are mostly applied for treatment of MRSA bacteraemia and important combination partners were highly susceptible. Copyright © 2015. Published by Elsevier Ltd.
    Clinical Microbiology and Infection 02/2015; 21(8). DOI:10.1016/j.cmi.2015.02.013 · 5.77 Impact Factor
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    Berliner und Münchener tierärztliche Wochenschrift 09/2014; 127(9-10):384-398.. · 0.82 Impact Factor
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    ABSTRACT: Methicillin-resistant Staphylococcus aureus (MRSA) causes colonization and infection both in animals and humans. In Germany, cases of MRSA colonization among humans, w+hich affect 0.5-1.5% of the general population and 1.0-2.5% of patients at hospital admission, are still mostly associated with previous healthcare contact and defined epidemic clonal lineages. However, MRSA is also distributed in livestock production in Germany, mostly without causing infections in the animals. These MRSA predominantly belong to the clonal complex (CC) 398, but also to CC9 and CC97. Zoonotic transmission of MRSA CC398 from livestock to humans occurs predominantly in people with occupational livestock contact. Spread of MRSA CC398 to household members of these persons is also frequently observed, but dissemination in the general population is limited so far However, especially in areas with intensive livestock husbandry, about 20-38% of MRSA CC398 cases among humans cannot be epidemiologically linked to direct livestock contact, indicating other transmission pathways. MRSA CC398 currently causes about 2% of all human MRSA infections (wound infections, pneumonia, sepsis) in Germany, but up to 10% in regions characterized by a high density of livestock-farming. The burden of MRSA in companion animals was demonstrated to range between 3.6-9.4% within wound samples obtained from dogs, cats and horses, respectively. In contrast to livestock and horses, MRSA distributed in pet animals are mostly associated with MRSA clonal lineages that are also prevalent in human healthcare facilities. Overall, zoonotic exchange of MRSA between humans and animals has relevant impact on the epidemiology of MRSA in Germany.
    Berliner und Münchener tierärztliche Wochenschrift 09/2014; 127(9-10):384-98. DOI:10.2376/0005-9366-127-384 · 0.82 Impact Factor

  • Berliner und Münchener tierärztliche Wochenschrift 09/2014; 127(9-10):384-398.. · 0.82 Impact Factor
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    Carmen Dahms · Nils-Olaf Hübner · Christiane Cuny · Axel Kramer ·
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    ABSTRACT: Background Livestock-associated methicillin-resistant Staphylococcus aureus (LA-MRSA) has a wide host range and is transmissible to humans, especially to those with close contact to colonized animals. This study presents the first data on the occurrence of MRSA in farm workers and livestock farms (pig, cattle and poultry) in the federal state of Mecklenburg-Western Pomerania in northeast Germany. 78 farm workers at pig farms, cattle farms and poultry farms were tested for MRSA via pooled nasal and pharyngeal swabs. Additionally, from each of the 34 participating farms (17 pig farms, 11 cattle farms, 6 poultry farms) five dust samples were taken from the direct surroundings of the animals. Furthermore, oropharyngeal swabs were additionally taken from 10 animals per poultry farm. Isolated MRSA strains were characterized and confirmed using PCR and spa typing. Resistance patterns were obtained using the broth microdilution assay. Results In total, 20 of 78 (25.6%; 95% CI:17.3-36.3) farm workers were positive for MRSA. All MRSA-positive workers were employed at pig farms. Six of 17 (35.3%; 95% CI:17.3-58.7) pooled dust samples from pig farms were also positive. Overall, six spa types were identified, of which t034 predominated. All strains belonged to LA-MRSA CC398 and were resistant to tetracycline. Resistance to lincosamides, macrolides, fluoroquinolones and aminoglycosides was present in some strains. Three farm workers harbored the identical spa type and antimicrobial resistance pattern found in the corresponding dust sample. Neither workers, dust samples from cattle and poultry farms, nor oropharyngeal poultry swabs tested positive for MRSA. Conclusions The present study emphasizes the importance of MRSA on pig farms and pig-farm workers in the rural region of Mecklenburg-Western Pomerania, whereas LA-MRSA could not be isolated from cattle and poultry farms.
    Acta Veterinaria Scandinavica 08/2014; 56(1):53. DOI:10.1186/s13028-014-0053-3 · 1.38 Impact Factor
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    ABSTRACT: In the early 2000s, a particular MRSA clonal complex (CC398) was found mainly in pigs and pig farmers in Europe. Since then, CC398 has been detected among a wide variety of animal species worldwide. We investigated the population structure of CC398 through mutation discovery at 97 genetic housekeeping loci, which are distributed along the CC398 chromosome within 195 CC398 isolates, collected from various countries and host species, including humans. Most of the isolates in this collection were received from collaborating microbiologists, who had preserved them over years. We discovered 96 bi-allelic polymorphisms, and phylogenetic analyses revealed that an epidemic sub-clone within CC398 (dubbed 'clade (C)') has spread within and between equine hospitals, where it causes nosocomial infections in horses and colonises the personnel. While clade (C) was strongly associated with S. aureus from horses in veterinary-care settings (p = 2×10(-7)), it remained extremely rare among S. aureus isolates from human infections.
    PLoS ONE 02/2014; 9(2):e88083. DOI:10.1371/journal.pone.0088083 · 3.23 Impact Factor
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    Christiane Cuny · Franziska Layer · Robin Köck · Guido Werner · Wolfgang Witte ·
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    ABSTRACT: Methicillin-susceptible Staphylococcus aureus (MSSA) attributed to clonal complex (CC) 398 and exhibiting spa-type t571 received attention in Europe and in the USA for being associated with severe infections in humans. As this spa-type is exhibited by livestock-associated (LA) Methicillin-resistant S. aureus (MRSA) as well, it is important to discriminate LA- and human-derived strains by easy to perform, PCR-based methods. MSSA t571 contain phage int3 carrying scn and chp, whereas LA-MRSA t571 lack these markers. In contrast, pathogenicity island SaPIbov5 (detected by PCR bridging vwbbov and scn) is contained by LA-MRSA t571 and absent in the human MSSA subpopulation. Furthermore, MSSA t571 contain erm(T), the particular genomic arrangement of which was assessed by a PCR bridging erm(T) and the adjacent transposase gene. MSSA t571 are rare so far in Germany among isolates from infections in humans (0.14%) as well as among isolates from nasal colonization (0.13%). LA-MRSA t571 are also infrequent among MRSA isolated from carriage at admission to hospitals (0.1%) and also among isolates from infections in humans (0.013%).
    PLoS ONE 12/2013; 8(12):e83165. DOI:10.1371/journal.pone.0083165 · 3.23 Impact Factor
  • Christiane Cuny · Robin Köck · Wolfgang Witte ·
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    ABSTRACT: Livestock-associated Staphylococcus aureus (LA-MRSA) are mainly associated with the clonal complex (CC) 398. Although having its main reservoir as MRSA in livestock such as pigs, poultry or cattle LA-MRSA CC398 has no pronounced host specificity and can colonize or infect other animals such as horses and dogs and also humans. In German conventional farming systems nasal colonization of the animals and of humans occupationally exposed to them (up to 86%) are frequent. Further human-to-human dissemination in households occurs more rarely in general (∼4% of humans living on farms but without occupational exposition). Nasal colonization with LA-MRSA of humans at hospital admission is found in 0.08-0.2% for Germany in general. However, this proportion is higher in areas with a high density of livestock production such as in northwestern North Rhine-Westphalia or Lower Saxony. LA-MRSA CC398 is not less pathogenic for humans than S. aureus in general. Hence, LA-MRSA accounts for ∼15% of all MRSA isolates from deep-seated skin and soft-tissue infections in the community and for about 0.8-2% of all MRSA isolated from clinical specimens obtained in hospital settings. When introduced into the hospital it can cause postoperative wound infections and even septicemia. Differently from hospital-associated MRSA clones, LA-MRSA CC398 has obviously limited capacity to spread in the nosocomial setting so far (proportion of ∼1.8% among MRSA from nosocomial infections, the proportion among MRSA from blood cultures is ∼1%).
    International journal of medical microbiology: IJMM 04/2013; 303(6-7). DOI:10.1016/j.ijmm.2013.02.010 · 3.61 Impact Factor
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    ABSTRACT: We investigated the population structure of Staphylococcus aureus clonal complex CC121 by mutation discovery at 115 genetic housekeeping loci from each of 154 isolates, sampled on five continents between 1953 and 2009. In addition, we pyro-sequenced the genomes from ten representative isolates. The genome-wide SNPs that were ascertained revealed the evolutionary history of CC121, indicating at least six major clades (A to F) within the clonal complex and dating its most recent common ancestor to the pre-antibiotic era. The toxin gene complement of CC121 isolates was correlated with their SNP-based phylogeny. Moreover, we found a highly significant association of clinical phenotypes with phylogenetic affiliations, which is unusual for S. aureus. All isolates evidently sampled from superficial infections (including staphylococcal scalded skin syndrome, bullous impetigo, exfoliative dermatitis, conjunctivitis) clustered in clade F, which included the European epidemic fusidic-acid resistant impetigo clone (EEFIC). In comparison, isolates from deep-seated infections (abscess, furuncle, pyomyositis, necrotizing pneumonia) were disseminated in several clades, but not in clade F. Our results demonstrate that phylogenetic lineages with distinct clinical properties exist within an S. aureus clonal complex, and that SNPs serve as powerful discriminatory markers, able to identify these lineages. All CC121 genomes harboured a 41-kilobase prophage that was dissimilar to S. aureus phages sequenced previously. Community-associated MRSA and MSSA from Cambodia were extremely closely related, suggesting this MRSA arose in the region.
    PLoS ONE 03/2013; 8(3):e58155. DOI:10.1371/journal.pone.0058155 · 3.23 Impact Factor
  • C. Cuny · W. Witte ·
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    ABSTRACT: During the past 20 years methicillin resistant S. aureus (MRSA) became a public health problem in hospitals worldwide (HA-MRSA). Furthermore, MRSA emerged independent upon nosocomial settings and spread in the community (CA-MRSA). At last 10% of the MRSA-infections in humans are caused by livestock associated MRSA (LA-MRSA). Livestock associated MRSA are mainly represented by clonal complex CC398 of this species. It obviously evolved from humans, who adapted methicillin susceptible S. aureus (MSSA) of this clonal complex, although having its main reservoir as MRSA in livestock such as pigs or poultry. In conventional farming systems nasal colonisation of the animals and of humans occupationally exposed to them is frequent with 77-86%. It was not found in pigs raised in alternative systems. Dissemination to humans beyond animal contacts is obviously rare with 4-5% of humans living on farms but without occupational exposition. When introduced into the hospital it can cause postoperative wound infections and even septicemia. Livestock farmers are included in the group of patients as risk for which a screening at hospital admission is recommended. Although LA-MRSA exhibit mulliresistance to a number of antibiotics, there are still sufficient treatment options left. As transferable resistance to linezolid originated in coagulase negative staphylococci from farm animals, emergence of this resistance trait in LA-MRSA and further spread to HA-MRSA needs particular attention. LA-MRSA came as an MSSA from humans and adapted to animals. The way back be future acquisition of transferable mobile genetic elements containing immune evasion and/or virulence genes needs to be detected intime.
  • F Layer · C Cuny · B Strommenger · G Werner · W Witte ·
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    ABSTRACT: Nosocomial infections caused by methicillin-resistant Staphylococcus aureus (MRSA) are a problem in hospital settings worldwide. The National Reference Centre for Staphylococci performs molecular typing on a representative sample set of MRSA isolates from German hospitals for assessing long-term trends thus following the dynamics of emergence and spread of MRSA clones. The article focuses on recent data concerning antibiotic resistance and epidemic MRSA in nosocomial settings and also reflects the impact of community-acquired MRSA and MRSA from zoonotic reservoirs. Identifying common and newly emerging clones is an on-going challenge in the changing epidemiology of MRSA and prevention of further spread needs molecular surveillance.
    Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz 11/2012; 55(11-12):1377-86. · 1.42 Impact Factor
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    ABSTRACT: Methicillin-resistente Staphylococcus aureus (MRSA) gehören weltweit zu den häufigsten Erregern nosokomialer Infektionen. Am Nationalen Referenzzentrum (NRZ) für Staphylokokken wird stetig eine repräsentative Anzahl an Isolaten aus deutschen Krankenhäusern und anderen medizinischen Einrichtungen analysiert, um die Dynamik des Auftretens und der Verbreitung von MRSA-Klonen zu verfolgen. Gemäß den vom NRZ vorgegebenen Kriterien für die Einsendung, werden vor allem Isolate aus einem gehäuften Auftreten von Infektionen sowie aus schweren Infektionsverläufen eingesandt. Der vorliegende Beitrag befasst sich mit aktuellen Daten aus dem NRZ für Staphylokokken zu Antibiotikaresistenzen und MRSA-Epidemiestämmen krankenhausassoziierter Infektionen. Weiterhin werden Ergebnisse zu Community-assoziierten MRSA, die außerhalb medizinischer Einrichtungen auftreten, und zu MRSA aus zoonotischen Reservoiren vorgestellt und diskutiert.
    Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz 11/2012; 55(11-12). DOI:10.1007/s00103-012-1560-x · 1.42 Impact Factor
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    ABSTRACT: Since the relationship between dogs and their owners has changed, and dogs moved from being working dogs to family members in post-industrial countries, we hypothesized that zoonotic transmission of opportunistic pathogens like coagulase positive staphylococci (CPS) is likely between dogs and their owners. CPS- nasal carriage, different aspects of human-to-dog relationship as well as potential interspecies transmission risk factors were investigated by offering nasal swabs and a questionnaire to dog owners (108) and their dogs (108) at a dog show in 2009. S. aureus was found in swabs of 20 (18.5%) humans and two dogs (1.8%), and spa types which correspond to well known human S. aureus lineages dominated (e.g. CC45, CC30 and CC22). Multilocus sequence typing (MLST) of the two canine strains revealed ST72 and ST2065 (single locus variant of ST34). Fifteen dogs (13.9%) and six owners (5.6%) harboured S. pseudintermedius, including one mecA-positive human isolate (MRSP). Pulsed field gel electrophoresis (PFGE) revealed that one dog/owner pair harboured indistinguishable S. pseudintermedius- isolates of ST33. Ten (48%) of the 21 S. pseudintermedius-isolates showed resistance towards more than one antimicrobial class. 88.9% of the dog owners reported to allow at least one dog into the house, 68.5% allow the dog(s) to rest on the sofa, 39.8% allow their dogs to come onto the bed, 93.5% let them lick their hands and 52.8% let them lick their face. Bivariate analysis of putative risk factors revealed that dog owners who keep more than two dogs have a significantly higher chance of being colonized with S. pseudintermedius than those who keep 1-2 dogs (p<0.05). In conclusion, CPS transmission between dog owners and their dogs is possible. Further investigation regarding interspecies transmission and the diverse adaptive pathways influencing the epidemiology of CPS (including MRSA and MRSP) in different hosts is needed.
    PLoS ONE 04/2012; 7(4):e35197. DOI:10.1371/journal.pone.0035197 · 3.23 Impact Factor
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    Christiane Cuny · Alexander W Friedrich · Wolfgang Witte ·
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    ABSTRACT: Livestock-associated methicillin-resistant Staphylococcus aureus (LA-MRSA) ST398 isolated from pigs raised in conventional farms was previously reported. Here we report a study on 25 farms adhering to an alternative system. LA-MRSA ST398 was not detected in nasal swabs from 178 pigs or from 89 humans working and living on these farms.
    Applied and Environmental Microbiology 12/2011; 78(4):1296-7. DOI:10.1128/AEM.07260-11 · 3.67 Impact Factor

Publication Stats

2k Citations
187.69 Total Impact Points


  • 1993-2015
    • Robert Koch Institut
      • Department for Infectious Disease Epidemiology
      Berlín, Berlin, Germany
  • 2011
    • Universitair Medisch Centrum Groningen
      Groningen, Groningen, Netherlands
  • 2007
    • University of Veterinary Medicine in Vienna
      Wien, Vienna, Austria