Cytotoxic Virulence Predicts Mortality in Nosocomial Pneumonia Due to Methicillin-Resistant Staphylococcus aureus
The current study identified bacterial factors that may improve management of methicillin-resistant Staphylococcus aureus (MRSA) nosocomial pneumonia. Isolates were obtained from 386 patients enrolled in a randomized, controlled study of antibiotic efficacy. Isolates were screened for production of...
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| Veröffentlicht in: | The Journal of infectious diseases 2015-06, Vol.211 (12), p.1862-1874 |
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| container_title | The Journal of infectious diseases |
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| creator | Rose, Hannah R. Holzman, Robert S. Altman, Deena R. Smyth, Davida S. Wasserman, Gregory A. Kafer, Jared M. Wible, Michelle Mendes, Rodrigo E. Torres, Victor J. Shopsin, Bo |
| description | The current study identified bacterial factors that may improve management of methicillin-resistant Staphylococcus aureus (MRSA) nosocomial pneumonia. Isolates were obtained from 386 patients enrolled in a randomized, controlled study of antibiotic efficacy. Isolates were screened for production of virulence factors and for vancomycin susceptibility. After adjustment for host factors such as severity of illness and treatment modality, cytotoxic activity was strongly and inversely associated with mortality; however, it had no effect on clinical cure. Isolates having low cytotoxicity, which were derived largely from healthcare-associated clones, exhibited a greater prevalence of vancomycin heteroresistance, and they were recovered more often from patients who were older and frailer. Additionally, a clone with low cytotoxic activity was associated with death and poor clinical improvement. Clone specificity and attenuated virulence appear to be associated with outcome. To our knowledge, these are the first correlations between MRSA virulence and mortality in nosocomial pneumonia. |
| doi_str_mv | 10.1093/infdis/jiu554 |
| format | Article |
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Isolates were obtained from 386 patients enrolled in a randomized, controlled study of antibiotic efficacy. Isolates were screened for production of virulence factors and for vancomycin susceptibility. After adjustment for host factors such as severity of illness and treatment modality, cytotoxic activity was strongly and inversely associated with mortality; however, it had no effect on clinical cure. Isolates having low cytotoxicity, which were derived largely from healthcare-associated clones, exhibited a greater prevalence of vancomycin heteroresistance, and they were recovered more often from patients who were older and frailer. Additionally, a clone with low cytotoxic activity was associated with death and poor clinical improvement. Clone specificity and attenuated virulence appear to be associated with outcome. To our knowledge, these are the first correlations between MRSA virulence and mortality in nosocomial pneumonia.</description><identifier>ISSN: 0022-1899</identifier><identifier>EISSN: 1537-6613</identifier><identifier>DOI: 10.1093/infdis/jiu554</identifier><identifier>PMID: 25298028</identifier><language>eng</language><publisher>United States: Oxford University Press</publisher><subject>Adolescent ; Adult ; Aged ; Aged, 80 and over ; Anti-Bacterial Agents - pharmacology ; BACTERIA ; Bacterial Toxins - toxicity ; Cell Line ; Cell Survival - drug effects ; Cross Infection - microbiology ; Cross Infection - mortality ; Culture Media - toxicity ; Female ; Humans ; Major and Brief Reports ; Male ; Methicillin-Resistant Staphylococcus aureus - growth & development ; Methicillin-Resistant Staphylococcus aureus - isolation & purification ; Methicillin-Resistant Staphylococcus aureus - pathogenicity ; Middle Aged ; Neutrophils - drug effects ; Pneumonia, Staphylococcal - microbiology ; Pneumonia, Staphylococcal - mortality ; Vancomycin - pharmacology ; Virulence ; Virulence Factors - analysis ; Young Adult</subject><ispartof>The Journal of infectious diseases, 2015-06, Vol.211 (12), p.1862-1874</ispartof><rights>Copyright © 2015 Oxford University Press on behalf of the Infectious Diseases Society of America</rights><rights>The Author 2014. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.</rights><rights>The Author 2014. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. For Permissions, please e-mail: . 2014</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c370t-8ab6ba77e2704ddca626bbf505d0ecb58ff9da21770511be1c92dd48738339133</citedby><cites>FETCH-LOGICAL-c370t-8ab6ba77e2704ddca626bbf505d0ecb58ff9da21770511be1c92dd48738339133</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.jstor.org/stable/pdf/43709549$$EPDF$$P50$$Gjstor$$H</linktopdf><linktohtml>$$Uhttps://www.jstor.org/stable/43709549$$EHTML$$P50$$Gjstor$$H</linktohtml><link.rule.ids>230,314,780,784,803,885,27924,27925,58017,58250</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/25298028$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Rose, Hannah R.</creatorcontrib><creatorcontrib>Holzman, Robert S.</creatorcontrib><creatorcontrib>Altman, Deena R.</creatorcontrib><creatorcontrib>Smyth, Davida S.</creatorcontrib><creatorcontrib>Wasserman, Gregory A.</creatorcontrib><creatorcontrib>Kafer, Jared M.</creatorcontrib><creatorcontrib>Wible, Michelle</creatorcontrib><creatorcontrib>Mendes, Rodrigo E.</creatorcontrib><creatorcontrib>Torres, Victor J.</creatorcontrib><creatorcontrib>Shopsin, Bo</creatorcontrib><title>Cytotoxic Virulence Predicts Mortality in Nosocomial Pneumonia Due to Methicillin-Resistant Staphylococcus aureus</title><title>The Journal of infectious diseases</title><addtitle>J Infect Dis</addtitle><description>The current study identified bacterial factors that may improve management of methicillin-resistant Staphylococcus aureus (MRSA) nosocomial pneumonia. Isolates were obtained from 386 patients enrolled in a randomized, controlled study of antibiotic efficacy. Isolates were screened for production of virulence factors and for vancomycin susceptibility. After adjustment for host factors such as severity of illness and treatment modality, cytotoxic activity was strongly and inversely associated with mortality; however, it had no effect on clinical cure. Isolates having low cytotoxicity, which were derived largely from healthcare-associated clones, exhibited a greater prevalence of vancomycin heteroresistance, and they were recovered more often from patients who were older and frailer. Additionally, a clone with low cytotoxic activity was associated with death and poor clinical improvement. Clone specificity and attenuated virulence appear to be associated with outcome. To our knowledge, these are the first correlations between MRSA virulence and mortality in nosocomial pneumonia.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Anti-Bacterial Agents - pharmacology</subject><subject>BACTERIA</subject><subject>Bacterial Toxins - toxicity</subject><subject>Cell Line</subject><subject>Cell Survival - drug effects</subject><subject>Cross Infection - microbiology</subject><subject>Cross Infection - mortality</subject><subject>Culture Media - toxicity</subject><subject>Female</subject><subject>Humans</subject><subject>Major and Brief Reports</subject><subject>Male</subject><subject>Methicillin-Resistant Staphylococcus aureus - growth & development</subject><subject>Methicillin-Resistant Staphylococcus aureus - isolation & purification</subject><subject>Methicillin-Resistant Staphylococcus aureus - pathogenicity</subject><subject>Middle Aged</subject><subject>Neutrophils - drug effects</subject><subject>Pneumonia, Staphylococcal - microbiology</subject><subject>Pneumonia, Staphylococcal - mortality</subject><subject>Vancomycin - pharmacology</subject><subject>Virulence</subject><subject>Virulence Factors - analysis</subject><subject>Young Adult</subject><issn>0022-1899</issn><issn>1537-6613</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2015</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpVkEtP3DAURq0KVKbQZZcg_4EUP-LY3iChoS-Jlwp0Gzm207mjjD3YTsX8-6ZKOyqru7jn-67uQegDJR8p0fwcQu8gn69hFKJ-gxZUcFk1DeUHaEEIYxVVWh-hdzmvCSE1b-RbdMQE04owtUDPy12JJb6AxT8gjYMP1uP75B3YkvFNTMUMUHYYAr6NOdq4ATPg--DHTQxg8NXocYn4xpcVWBgGCNV3nyEXEwp-KGa72g1TytoxYzMmP-YTdNibIfv3f-cxevr86XH5tbq--_JteXldWS5JqZTpms5I6ZkktXPWNKzpul4Q4Yi3nVB9r51hVEoiKO08tZo5VyvJFeeacn6MLube7dhtvLM-lGSGdptgY9KujQba15sAq_Zn_NXWapJE1VRQzQU2xZyT7_dZSto_7tvZfTu7n_iz_w_u6X-yJ-B0Bta5xLTf19O_WtSa_wa0YpB1</recordid><startdate>20150615</startdate><enddate>20150615</enddate><creator>Rose, Hannah R.</creator><creator>Holzman, Robert S.</creator><creator>Altman, Deena R.</creator><creator>Smyth, Davida S.</creator><creator>Wasserman, Gregory A.</creator><creator>Kafer, Jared M.</creator><creator>Wible, Michelle</creator><creator>Mendes, Rodrigo E.</creator><creator>Torres, Victor J.</creator><creator>Shopsin, Bo</creator><general>Oxford University Press</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>5PM</scope></search><sort><creationdate>20150615</creationdate><title>Cytotoxic Virulence Predicts Mortality in Nosocomial Pneumonia Due to Methicillin-Resistant Staphylococcus aureus</title><author>Rose, Hannah R. ; Holzman, Robert S. ; Altman, Deena R. ; Smyth, Davida S. ; Wasserman, Gregory A. ; Kafer, Jared M. ; Wible, Michelle ; Mendes, Rodrigo E. ; Torres, Victor J. ; Shopsin, Bo</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c370t-8ab6ba77e2704ddca626bbf505d0ecb58ff9da21770511be1c92dd48738339133</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2015</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Anti-Bacterial Agents - pharmacology</topic><topic>BACTERIA</topic><topic>Bacterial Toxins - toxicity</topic><topic>Cell Line</topic><topic>Cell Survival - drug effects</topic><topic>Cross Infection - microbiology</topic><topic>Cross Infection - mortality</topic><topic>Culture Media - toxicity</topic><topic>Female</topic><topic>Humans</topic><topic>Major and Brief Reports</topic><topic>Male</topic><topic>Methicillin-Resistant Staphylococcus aureus - growth & development</topic><topic>Methicillin-Resistant Staphylococcus aureus - isolation & purification</topic><topic>Methicillin-Resistant Staphylococcus aureus - pathogenicity</topic><topic>Middle Aged</topic><topic>Neutrophils - drug effects</topic><topic>Pneumonia, Staphylococcal - microbiology</topic><topic>Pneumonia, Staphylococcal - mortality</topic><topic>Vancomycin - pharmacology</topic><topic>Virulence</topic><topic>Virulence Factors - analysis</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Rose, Hannah R.</creatorcontrib><creatorcontrib>Holzman, Robert S.</creatorcontrib><creatorcontrib>Altman, Deena R.</creatorcontrib><creatorcontrib>Smyth, Davida S.</creatorcontrib><creatorcontrib>Wasserman, Gregory A.</creatorcontrib><creatorcontrib>Kafer, Jared M.</creatorcontrib><creatorcontrib>Wible, Michelle</creatorcontrib><creatorcontrib>Mendes, Rodrigo E.</creatorcontrib><creatorcontrib>Torres, Victor J.</creatorcontrib><creatorcontrib>Shopsin, Bo</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>The Journal of infectious diseases</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Rose, Hannah R.</au><au>Holzman, Robert S.</au><au>Altman, Deena R.</au><au>Smyth, Davida S.</au><au>Wasserman, Gregory A.</au><au>Kafer, Jared M.</au><au>Wible, Michelle</au><au>Mendes, Rodrigo E.</au><au>Torres, Victor J.</au><au>Shopsin, Bo</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Cytotoxic Virulence Predicts Mortality in Nosocomial Pneumonia Due to Methicillin-Resistant Staphylococcus aureus</atitle><jtitle>The Journal of infectious diseases</jtitle><addtitle>J Infect Dis</addtitle><date>2015-06-15</date><risdate>2015</risdate><volume>211</volume><issue>12</issue><spage>1862</spage><epage>1874</epage><pages>1862-1874</pages><issn>0022-1899</issn><eissn>1537-6613</eissn><abstract>The current study identified bacterial factors that may improve management of methicillin-resistant Staphylococcus aureus (MRSA) nosocomial pneumonia. Isolates were obtained from 386 patients enrolled in a randomized, controlled study of antibiotic efficacy. Isolates were screened for production of virulence factors and for vancomycin susceptibility. After adjustment for host factors such as severity of illness and treatment modality, cytotoxic activity was strongly and inversely associated with mortality; however, it had no effect on clinical cure. Isolates having low cytotoxicity, which were derived largely from healthcare-associated clones, exhibited a greater prevalence of vancomycin heteroresistance, and they were recovered more often from patients who were older and frailer. Additionally, a clone with low cytotoxic activity was associated with death and poor clinical improvement. Clone specificity and attenuated virulence appear to be associated with outcome. To our knowledge, these are the first correlations between MRSA virulence and mortality in nosocomial pneumonia.</abstract><cop>United States</cop><pub>Oxford University Press</pub><pmid>25298028</pmid><doi>10.1093/infdis/jiu554</doi><tpages>13</tpages><oa>free_for_read</oa></addata></record> |
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| source | MEDLINE; JSTOR Archive Collection A-Z Listing; Oxford University Press Journals All Titles (1996-Current); Alma/SFX Local Collection |
| subjects | Adolescent Adult Aged Aged, 80 and over Anti-Bacterial Agents - pharmacology BACTERIA Bacterial Toxins - toxicity Cell Line Cell Survival - drug effects Cross Infection - microbiology Cross Infection - mortality Culture Media - toxicity Female Humans Major and Brief Reports Male Methicillin-Resistant Staphylococcus aureus - growth & development Methicillin-Resistant Staphylococcus aureus - isolation & purification Methicillin-Resistant Staphylococcus aureus - pathogenicity Middle Aged Neutrophils - drug effects Pneumonia, Staphylococcal - microbiology Pneumonia, Staphylococcal - mortality Vancomycin - pharmacology Virulence Virulence Factors - analysis Young Adult |
| title | Cytotoxic Virulence Predicts Mortality in Nosocomial Pneumonia Due to Methicillin-Resistant Staphylococcus aureus |
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