BACKGROUND: Of the 13 US vancomycin-resistant Staphylococcus aureus (VRSA) cases, 8 were identified in southeastern Michigan, primarily in patients with chronic lower-extremity wounds. VRSA infections develop when the vanA gene from vancomycin-resistant enterococcus (VRE) transfers to S. aureus. Inc18-like plasmids in VRE and pSK41-like plasmids in S. aureus appear to be important precursors to this transfer. OBJECTIVE: Identify the prevalence of VRSA precursor organisms. DESIGN: Prospective cohort with embedded case-control study. PARTICIPANTS: Southeastern Michigan adults with chronic lower-extremity wounds. METHODS: Adults presenting to 3 southeastern Michigan medical centers during the period February 15 through March 4, 2011, with chronic lower-extremity wounds had wound, nares, and perirectal swab specimens cultured for S. aureus and VRE, which were tested for pSK41-like and Inc18-like plasmids by polymerase chain reaction. We interviewed participants and reviewed clinical records. Risk factors for pSK41-positive S. aureus were assessed among all study participants (cohort analysis) and among only S. aureus-colonized participants (case-control analysis). RESULTS: Of 179 participants with wound cultures, 26% were colonized with methicillin-susceptible S. aureus, 27% were colonized with methicillin-resistant S. aureus, and 4% were colonized with VRE, although only 17% consented to perirectal culture. Six participants (3%) had pSK41-positive S. aureus, and none had Inc18-positive VRE. Having chronic wounds for over 2 years was associated with pSK41-positive S. aureus colonization in both analyses. CONCLUSIONS: Colonization with VRSA precursor organisms was rare. Having long-standing chronic wounds was a risk factor for pSK41-positive S. aureus colonization. Additional investigation into the prevalence of VRSA precursors among a larger cohort of patients is warranted.
BACKGROUND: Of the 13 US vancomycin-resistant Staphylococcus aureus (VRSA) cases, 8 were identified in southeastern Michigan, primarily in patients with chronic lower-extremity wounds. VRSA infections develop when the vanA gene from vancomycin-resistant enterococcus (VRE) transfers to S. aureus. Inc18-like plasmids in VRE and pSK41-like plasmids in S. aureus appear to be important precursors to this transfer. OBJECTIVE: Identify the prevalence of VRSA precursor organisms. DESIGN: Prospective cohort with embedded case-control study. PARTICIPANTS: Southeastern Michigan adults with chronic lower-extremity wounds. METHODS: Adults presenting to 3 southeastern Michigan medical centers during the period February 15 through March 4, 2011, with chronic lower-extremity wounds had wound, nares, and perirectal swab specimens cultured for S. aureus and VRE, which were tested for pSK41-like and Inc18-like plasmids by polymerase chain reaction. We interviewed participants and reviewed clinical records. Risk factors for pSK41-positive S. aureus were assessed among all study participants (cohort analysis) and among only S. aureus-colonized participants (case-control analysis). RESULTS: Of 179 participants with wound cultures, 26% were colonized with methicillin-susceptible S. aureus, 27% were colonized with methicillin-resistant S. aureus, and 4% were colonized with VRE, although only 17% consented to perirectal culture. Six participants (3%) had pSK41-positive S. aureus, and none had Inc18-positive VRE. Having chronic wounds for over 2 years was associated with pSK41-positive S. aureus colonization in both analyses. CONCLUSIONS: Colonization with VRSA precursor organisms was rare. Having long-standing chronic wounds was a risk factor for pSK41-positive S. aureus colonization. Additional investigation into the prevalence of VRSA precursors among a larger cohort of patients is warranted.
Authors: Linda M Weigel; Rodney M Donlan; Dong Hyeon Shin; Bette Jensen; Nancye C Clark; Linda K McDougal; Wenming Zhu; Kimberlee A Musser; Jill Thompson; Donna Kohlerschmidt; Nellie Dumas; Ronald J Limberger; Jean B Patel Journal: Antimicrob Agents Chemother Date: 2006-10-30 Impact factor: 5.191
Authors: Brandi Limbago; Gregory E Fosheim; Valerie Schoonover; Christina E Crane; Joelle Nadle; Susan Petit; David Heltzel; Susan M Ray; Lee H Harrison; Ruth Lynfield; Ghinwa Dumyati; John M Townes; William Schaffner; Yi Mu; Scott K Fridkin Journal: J Clin Microbiol Date: 2009-03-25 Impact factor: 5.948
Authors: Fred C Tenover; Linda M Weigel; Peter C Appelbaum; Linda K McDougal; Jasmine Chaitram; Sigrid McAllister; Nancye Clark; George Killgore; Caroline M O'Hara; Laura Jevitt; Jean B Patel; Bülent Bozdogan Journal: Antimicrob Agents Chemother Date: 2004-01 Impact factor: 5.191
Authors: Wenming Zhu; Nancye C Clark; Linda K McDougal; Jeffery Hageman; L Clifford McDonald; Jean B Patel Journal: Antimicrob Agents Chemother Date: 2007-12-03 Impact factor: 5.191
Authors: Dawn M Sievert; James T Rudrik; Jean B Patel; L Clifford McDonald; Melinda J Wilkins; Jeffrey C Hageman Journal: Clin Infect Dis Date: 2008-03-01 Impact factor: 9.079
Authors: Brandi M Limbago; Alexander J Kallen; Wenming Zhu; Paula Eggers; Linda K McDougal; Valerie S Albrecht Journal: J Clin Microbiol Date: 2013-12-26 Impact factor: 5.948