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Methicillin-Resistant Staphylococcus aureus: HELP
Articles from Athens, GR
Based on 48 articles published since 2009

These are the 48 published articles about Methicillin-Resistant Staphylococcus aureus that originated from Athens, GR during 2009-2019.
+ Citations + Abstracts
Pages: 1 · 2
1 Editorial Oxacillin-susceptible MRSA: could it become a successful MRSA type? 2013

Pournaras, Spyros / Stathopoulos, Constantinos / Tsakris, Athanassios. ·Department of Microbiology, Medical School, University of Athens, Athens, Greece. ·Future Microbiol · Pubmed #24199795.

ABSTRACT: -- No abstract --

2 Review The Impact of Antibiotic Stewardship Programs in Combating Quinolone Resistance: A Systematic Review and Recommendations for More Efficient Interventions. 2017

Pitiriga, Vasiliki / Vrioni, Georgia / Saroglou, George / Tsakris, Athanasios. ·Department of Microbiology, Medical School, University of Athens, Athens, Greece. · Metropolitan General Hospital, Piraeus, Greece. · Department of Microbiology, Medical School, University of Athens, Athens, Greece. atsakris@med.uoa.gr. ·Adv Ther · Pubmed #28303388.

ABSTRACT: Quinolones are among the most commonly prescribed antibiotics worldwide. A clear relationship has been demonstrated between excessive quinolone use and the steady increase in the incidence of quinolone-resistant bacterial pathogens, both in hospital and community sites. In addition, exposure to quinolones has been associated with colonization and infection with healthcare-associated pathogens such as methicillin-resistant Staphylococcus aureus and Clostridium difficile in hospitalized patients. Therefore, the management of quinolone prescribing in hospitals through antibiotic stewardship programs is considered crucial. Although suggestions have been made by previous studies on the positive impact of stewardship programs concerning the emergence and spread of multidrug-resistant bacteria at hospital level, the association of quinolone-targeted interventions with reduction of quinolone resistance is vague. The purpose of this article was to evaluate the impact of stewardship interventions on quinolone resistance rates and healthcare-associated infections, through a literature review using systematic methods to identify and select the appropriate studies. Recommendations for improvements in quinolone-targeted stewardship programs are also proposed. Efforts in battling quinolone resistance should combine various interventions such as restriction formulary policies, prospective audits with feedback to prescribers, infection prevention and control measures, prompt detection of low-level resistance, educational programs, and guidelines for optimal quinolone usage. However, the effectiveness of such strategies should be assessed by properly designed and conducted clinical trials. Finally, novel approaches in diagnostic stewardship for rapidly detecting bacterial resistance, including PCR-based techniques, mass spectrometry, microarrays, and whole-genome sequencing as well as the prompt investigation on the clonality of quinolone-resistant strains, will strengthen our ability to personalize quinolone prescribing to individual patients.

3 Review What is new in the management of skin and soft tissue infections in 2016? 2017

Poulakou, Garyphallia / Giannitsioti, Efthymia / Tsiodras, Sotirios. ·Fourth Department of Internal Medicine, Athens National and Kapodistrian University, School of Medicine, Attikon University General Hospital, Athens, Greece. ·Curr Opin Infect Dis · Pubmed #28134678.

ABSTRACT: PURPOSE OF REVIEW: Skin and soft tissue infections (SSTIs) are the most frequent infectious cause of referrals to emergency departments and hospital admissions in developed world, contributing to significant morbidity and healthcare expenditures. We sought to review recent literature covering epidemiology and management of SSTIs. RECENT FINDINGS: Incidence trends of SSTIs were increasing worldwide with Staphylococcus aureus and streptococci predominating and methicillin-resistant S. aureus (MRSA) posing additional challenges, because of high rates of treatment failure and relapse. Development of new antimicrobials was associated with an appraisal of regulatory definitions and endpoints. Prediction of clinical response can be very tricky, because of variable risk factors for recurrence or treatment failure, depending mostly on the host. Precise indications for new antimicrobials should be established; their integration into clinical practice algorithms may serve reduction of unnecessary admissions, overtreatment and total costs. SUMMARY: New antimicrobials with activity against MRSA have been recently launched. Long-acting agents, mainly oritavancin and dalbavancin, provide the opportunity of single-dose treatment and early discharge. Further outpatient treatment options include new per os antibiotics such as oxazolidinones. Validated assessment tools are urgently needed to support decision-making toward rational resource utilization and delivery of optimal treatment.

4 Review Methicillin-resistant food-related Staphylococcus aureus: a review of current knowledge and biofilm formation for future studies and applications. 2017

Doulgeraki, Agapi I / Di Ciccio, Pierluigi / Ianieri, Adriana / Nychas, George-John E. ·Laboratory of Microbiology and Biotechnology of Foods, Department of Food Science and Human Nutrition, Faculty of Foods, Biotechnology and Development, Agricultural University of Athens (AUA), Iera Odos 75, Athens, 11855, Greece. Electronic address: adoulgeraki@aua.gr. · Department of Food Science, University of Parma, Via del Taglio 10, 43126, Parma, Italy. · Laboratory of Microbiology and Biotechnology of Foods, Department of Food Science and Human Nutrition, Faculty of Foods, Biotechnology and Development, Agricultural University of Athens (AUA), Iera Odos 75, Athens, 11855, Greece. ·Res Microbiol · Pubmed #27542729.

ABSTRACT: There is increasing concern about the public health impact of methicillin-resistant Staphylococcus aureus. Food and animal are vectors of transmission, but the contribution of a contaminated environment is not well characterized. With regard to this, staphylococcal biofilms serve as a virulence factor, allowing MRSA strains to adhere to surfaces and other materials used in the food industry. Methicillin resistance and biofilm-forming capacity may contribute to the success of S. aureus as a human pathogen in both health care and community settings and the food production chain. This review summarizes current knowledge about the significance of food- and animal-derived MRSA strains and provides data on attachment and biofilm formation of MRSA. In addition, the impact of quorum sensing on MRSA gene expression and biofilm formation is examined.

5 Review Nosocomial pneumonia in 27 ICUs in Europe: perspectives from the EU-VAP/CAP study. 2017

Koulenti, D / Tsigou, E / Rello, J. ·Burns, Trauma and Critical Care Research Centre, The University of Queensland, Brisbane, Australia. · 2nd Critical Care Department, Attikon University Hospital, Athens, Greece. · Agioi Anargyroi General Hospital, University ICU, Athens, Greece. · CIBERES, Barcelona, Spain. jrello@crips.es. · Universitat Autonoma de Barcelona, Barcelona, Spain. jrello@crips.es. ·Eur J Clin Microbiol Infect Dis · Pubmed #27287765.

ABSTRACT: We report on intensive care nosocomial pneumonia (NP) in Europe through a review of EU-VAP/CAP manuscripts: a prospective observational study, enrolling patients from 27 ICUs in nine European countries. From 2,436 eligible ICU patients, 827 cases presented NP, with 18.3 episodes of VAP per 1000 ventilator-days. Most common findings were worsening oxygenation, purulent respiratory secretions and temperature increase. At least three criteria from Clinical Pulmonary Infection score (CPIS) were present in 77.9 % of episodes, but only 0.2 % met six CPIS criteria. Diagnosis was confirmed mainly noninvasively (74.8 %), with half qualitative and quantitative cultures. The dominant isolate was S. aureus in Spain, France, Belgium and Ireland, P. aeruginosa in Italy and Portugal, Acinetobacter in Greece and Turkey, but Escherichia coli in Germany. NP resulted in 6 % higher mortality, longer ICU stay and duration of mechanical ventilation (12 and 10 days). COPD and age ≥45 years were not associated with higher VAP incidence but did correlate with increased mortality. Trauma had higher VAP incidence but lower mortality. Bacteremia (led by MRSA and Acinetobacter baumannii) was documented in 14.6 %, being associated with extra ICU stay and mortality. Vasopressors and ICUs with above 25 % prevalence of Potential Resistant Organisms (PRM) were independently associated with PRM, being documented in 50.7 % of patients with early-onset VAP without known risk factors. Most patients initially received combination therapy. Delay in appropriate antimicrobial choice significantly increased mortality, and LOS in survivors was six days longer (p < 0.05). In conclusion, NP management in Europe presents local differences and major shifts when compared to reports from North America, outcomes of randomized trials and general guidelines.

6 Review Methicillin-resistant Staphylococcus aureus infections: A review of the currently available treatment options. 2016

Purrello, S M / Garau, J / Giamarellos, E / Mazzei, T / Pea, F / Soriano, A / Stefani, S. ·Medical Molecular Microbiology and Antibiotic Resistance Laboratory (MMAR Lab), Department of Biomedical and Biotechnological Sciences, University of Catania, Catania, Italy. · Department of Medicine, Hospital Universitari Mútua de Terrassa, Terrassa, Barcelona, Spain. · 4th Department of Internal Medicine, Attikon University Hospital, Athens, Greece. · Department of Health Sciences, Clinical Pharmacology and Oncology Section, University of Firenze, Firenze, Italy. · Institute of Clinical Pharmacology, Azienda Ospedaliero-Universitaria Santa Maria della Misericordia, Udine, Italy; Department of Experimental and Clinical Medical Sciences, University of Udine, Udine, Italy. · Department of Infectious Diseases, IDIBAPS, Hospital Clínic of Barcelona, Barcelona, Spain. · Medical Molecular Microbiology and Antibiotic Resistance Laboratory (MMAR Lab), Department of Biomedical and Biotechnological Sciences, University of Catania, Catania, Italy. Electronic address: stefanis@unict.it. ·J Glob Antimicrob Resist · Pubmed #27889013.

ABSTRACT: This review is the result of discussions that took place at the 5th MRSA Working Group Consensus Meeting and explores the possible treatment options available for different types of infections due to methicillin-resistant Staphylococcus aureus (MRSA), focusing on those antibiotics that could represent a valid alternative to vancomycin. In fact, whilst vancomycin remains a viable option, its therapy is moving towards individualised dosing. Other drugs, such as the new lipoglycopeptides (oritavancin, dalbavancin and telavancin) and fifth-generation cephalosporins (ceftaroline and ceftobiprole), are showing good in vitro potency and in vivo efficacy, especially for patients infected with micro-organisms with higher vancomycin minimum inhibitory concentrations (MICs). Tedizolid is an attractive agent for use both in hospital and community settings, but the post-marketing data will better clarify its potential. Daptomycin and linezolid have shown non-inferiority to vancomycin in the treatment of MRSA bacteraemia and non-inferiority/superiority to vancomycin in the treatment of hospital-acquired pneumonia. Thus, several options are available, but more data from clinical practice, especially for invasive infections, are needed to assign specific roles to each antibiotic and to definitely include them in the new antibacterial armamentarium.

7 Review Telavancin in the treatment of Staphylococcus aureus hospital-acquired and ventilator-associated pneumonia: clinical evidence and experience. 2016

Liapikou, Adamantia / Dimakou, Katerina / Toumbis, Michael. ·6 Respiratory Department, Sotiria Hospital, Mesogion 152, 11527, Athens Greecemliapikou@yahoo.com. · 5 Respiratory Department, Sotiria Hospital, Athens, Greece. · 6 Respiratory Department, Sotiria Hospital, Athens, Greece. ·Ther Adv Respir Dis · Pubmed #27340253.

ABSTRACT: Telavancin (TLV) is a lipoglycopeptide derivative of vancomycin (VAN), which has activity against Gram-positive aerobic bacteria, and is especially effective against methicillin-resistant Staphylococcus aureus (MRSA) and Gram-positive bacteria resistant to VAN. Comparative clinical studies of TLV have demonstrated noninferiority compared with VAN in the treatment of hospital-acquired Gram-positive pneumonia, with high cure rates for TLV-treated patients with monomicrobial S. aureus infection, including isolates with reduced VAN susceptibility. The results based on the patients' clinical response were supported by supplemental post-hoc analyses of 28-day mortality. In Europe and the USA, TLV is approved as a useful alternative for patients with difficult-to-treat, hospital-acquired MRSA pneumonia when there are very few alternatives. The present article reviews TLV's pharmacological characteristics and clinical efficacy resulting from clinical trials giving a detailed picture of its properties and position in the management of hospital-acquired pneumonia.

8 Review Pharmacodynamics, pharmacokinetics and clinical efficacy of telavancin in the treatment of pneumonia. 2016

Adamantia, Liapikou / Antoni, Torres. ·a 6th Respiratory Department , Sotiria Hospital , Athens , Greece. · b Department of Pneumology , Hospital Clinic of Barcelona , Barcelona , Spain. ·Expert Opin Drug Metab Toxicol · Pubmed #27158752.

ABSTRACT: INTRODUCTION: Telavancin is a novel lipoglycopeptide derivative of vancomycin that has activity against Gram-positive aerobic and anerobic bacteria, for the treatment of serious infections, including complicated skin and skin structure infections (cSSSI) and pneumonia. AREAS COVERED: This article was compiled through searches on telavancin up to December 2015 in the PubMed and the clinicaltrials.gov databases; the FDA and European Medicine Agency (EMA) websites. In our review, particular attention was paid to those articles that reviewed the pharmacokinetic characteristics of the drug and animal models of infection. We also searched for evidence of the efficacy of telavancin as demonstrated in clinical trials, safety and tolerability data and have compiled a summary of clinical trials on telavancin in pneumonia. EXPERT OPINION: Telavancin is approved in Europe and the USA for the treatment of nosocomial pneumonia caused by methicillin resistant Staphylococcus aureus when other alternatives are not suitable.

9 Review Driving Forces of Mechanisms Regulating Oxacillin-Resistance Phenotypes of MRSA: Truly Oxacillin-Susceptible mecA-Positive Staphylococcus aureus Clinical Isolates also Exist. 2015

Pournaras, Spyros / Sabat, Artur J / Grundmann, Hajo / Hendrix, Ron / Tsakris, Athanasios / Friedrich, Alexander W. ·Department of Microbiology, Medical School, University of Athens, Athens, Greece. ·Curr Pharm Des · Pubmed #25760336.

ABSTRACT: As MRSA are considered Staphylococcus aureus isolates with oxacillin minimum inhibitory concentration (MIC) of ≥4 mg/L or harboring the mecA gene. However, the presence of mecA does not necessarily lead to oxacillin resistance and mecA gene-carrying isolates may have oxacillin MIC within the susceptible range (≥2 mg/L). During the last few years it has become apparent that oxacillin-susceptible (OS) mecA-positive S. aureus isolates (commonly called OS-MRSA) are rather commonly detected worldwide and may remain undiagnosed using phenotypic susceptibility testing methods. This review will summarize the current reports on OS-MRSA isolations and the underlying mechanisms regulating the expression of oxacillin resistance and also oxacillin susceptibility in mecA-positive S. aureus isolates. As MRSA commonly cause severe infections against which effective therapies are limited, understanding of these mechanisms could enable the identification of new targets for the treatment or reversion of the MRSA phenotype.

10 Review Emerging drugs on methicillin-resistant Staphylococcus aureus. 2013

Liapikou, Adamantia / Torres, Antoni. ·Sotiria Hospital, 3rd Respiratory Department, Mesogion 152, 11527, Athens, Greece. mliapikou@yahoo.com ·Expert Opin Emerg Drugs · Pubmed #23848400.

ABSTRACT: INTRODUCTION: Methicillin-resistant Staphylococcus aureus (MRSA) has proven to be a prominent pathogen in hospitals and in the community, which is capable of causing a variety of severe infections. Until now, there has been a limited antimicrobial armamentarium for use against MRSA, of which glycopeptides and linezolid are the main agents used. AREAS COVERED: This review assesses current treatment and the agents being developed for MRSA infections. A search was conducted in PubMed for English-language references published from 2000 to 2013, using combinations of the following terms: 'MRSA', 'MRSA therapy', 'gram (+) infections therapy', 'new antibiotics', 'vancomycin', 'staphylococcus resistance', 'oritavancin', 'ceftaroline', 'linezolid' and 'tigecycline'. The clinicalTrials website was also searched with keywords regarding the new antibiotic agents against MRSA infections. EXPERT OPINION: There are a number of new agents, the place of which in therapeutic regimens is yet to emerge. New glycopeptides, such as dalbavancin and oritavancin, with long half-lives, enabling once-weekly dosing, and oral agents, such as iclaprim, may provide a treatment approach for outpatient therapy. A decision must be made regarding the most suitable agent for an individual patient, the site of infection and the place of therapy.

11 Review Impact of antimicrobial multidrug resistance on inpatient care cost: an evaluation of the evidence. 2013

Tansarli, Giannoula S / Karageorgopoulos, Drosos E / Kapaskelis, Anastasios / Falagas, Matthew E. ·Alfa Institute of Biomedical Sciences, 9 Neapoleos Street, 151 23 Marousi, Athens, Greece. ·Expert Rev Anti Infect Ther · Pubmed #23458771.

ABSTRACT: This article evaluates the in-hospital costs attributable to antimicrobial multidrug resistance, defined as the difference in averaged costs of the patients infected with a multidrug-resistant (MDR) versus a non-MDR organism. PubMed and Scopus databases were searched to identify relevant studies. Twenty four studies were included: four on carbapenem-resistant or MDR Gram negative nonfermenters, eight on extended-spectrum b-lactamase-producing Enterobacteriaceae and 12 on methicillin-resistant Staphylococcus aureus. In two studies on carbapenem-resistant nonfermenters, the attributable mean hospital charges were US$58,457 and 85,299, respectively. The attributable mean total costs were US$4484 in a study referring to MDR Acinetobacter baumannii, while that varied from US$1584 to 30,093 among studies on extended-spectrum b-lactamase-producing Enterobacteriaceae. With respect to methicillin-resistant S. aureus, the attributable mean total costs varied from US$1014 to 40,090. The in-hospital costs attributable to multidrug resistance are alarmingly high, justifying the application of strict infection control measures in medical institutions with increased rate of MDR infections.

12 Review Incidence, characteristics, and outcomes of patients with bone and joint infections due to community-associated methicillin-resistant Staphylococcus aureus: a systematic review. 2013

Vardakas, K Z / Kontopidis, I / Gkegkes, I D / Rafailidis, P I / Falagas, M E. ·Alfa Institute of Biomedical Sciences (AIBS), 9 Neapoleos Street, 151 23, Marousi, Athens, Greece. ·Eur J Clin Microbiol Infect Dis · Pubmed #23334662.

ABSTRACT: To summarize the published evidence of community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) bone and joint infections. PubMed and Scopus electronic databases were searched. The annual incidence of invasive CA-MRSA infections ranged from 1.6 to 29.7 cases per 100,000, depending on the location of the population studied; bone and joint infections accounted for 2.8 to 43 % of invasive CA-MRSA infections. Surveillance studies showed that patients <2 years of age are mainly affected. Incidence rates were higher in blacks. Sixty-seven case reports and case series were identified; the majority of the patients included were children. Vancomycin and clindamycin were used effectively, in addition to surgical interventions. Seven patients out of 413 died (1.7 %) in total. Chronic osteomyelitis developed in 19 patients (data for 164 patients were available). The published evidence for CA-MRSA bone and joint infections refers mainly to children; their incidence depends on the location and race of the population. Vancomycin and clindamycin have been used effectively for their treatment.

13 Review Community acquired methicillin resistant Staphylococcus aureus pneumonia: an update for the emergency and intensive care physician. 2012

Karampela, I / Poulakou, G / Dimopoulos, G. ·Department of Critical Care Medicine, University Hospital Attikon, Medical School University of Athens, Athens, Greece. ·Minerva Anestesiol · Pubmed #22531561.

ABSTRACT: Pneumonia caused by community-acquired (CA) methicillin-resistant Staphylococcus aureus (MRSA) among individuals without healthcare-associated (HA) risk factors was first recognized a decade ago. CA-MRSA has now been established as a pathogen responsible for rapidly progressive, frequently fatal disease manifesting as necrotizing pneumonia, severe sepsis and necrotizing fasciitis. The frequency of occurrence, risk factors, and optimal treatment of CA-MRSA pneumonia remain unclear and vary significantly across countries. CA-MRSA is resistant to β-lactam antimicrobials due to the acquisition of novel methicillin resistance genetic cassettes. Additionally many CA-MRSA strains produce Panton-Valentine leukocidin (PVL), due to which they probably exceed the virulence of hospital-acquired MRSA isolates (HA-MRSA). CA-MRSA pneumonia requires early suspicion -especially in young otherwise healthy individuals with rapidly evolving clinical picture presenting with cavitary consolidation, bilateral infiltrates, pleural effusion and hemoptysis. Prompt hospitalization and aggressive treatment with intravenous antibiotics is warranted to improve outcomes. Therapeutic approach for severe CA-MRSA infections and particularly pneumonia is generally the same as that for invasive HA-MRSA infections. New anti-MRSA agents and possible combinations are of great importance to be evaluated in the future.

14 Review MRSA blistering distal dactylitis and review of reported cases. 2011

Fretzayas, Andrew / Moustaki, Maria / Tsagris, Vasilios / Brozou, Triantafillia / Nicolaidou, Polyxeni. ·Athens University School of Medicine, 3rd Department of Pediatrics, Attikon University Hospital, Athens, Greece. ·Pediatr Dermatol · Pubmed #21438916.

ABSTRACT: We describe a 6-month-old infant with blistering distal dactylitis. Bacterial culture from the skin lesion grew methicillin resistant Staphylococcus aureus. No carriage of this bacterial agent was identified in her family. She responded to vancomycin administration and incision and drainage of the lesion. This is the first reported case of methicillin resistant Staphylococcus aureus-associated blistering distal dactylitis in an infant.

15 Review Methicillin-resistant Staphylococcus aureus in diabetic foot infections. 2010

Eleftheriadou, Ioanna / Tentolouris, Nicholas / Argiana, Vasiliki / Jude, Edward / Boulton, Andrew J. ·Department of Propaedeutic and Internal Medicine, Athens University Medical School, Greece. ·Drugs · Pubmed #20836573.

ABSTRACT: Diabetic foot ulcers are often complicated by infection. Among pathogens, Staphylococcus aureus predominates. The prevalence of methicillin-resistant S. aureus (MRSA) in infected foot ulcers is 15-30% and there is an alarming trend for increase in many countries. There are also data that recognize new strains of MRSA that are resistant to vancomycin. The risk for MRSA isolation increases in the presence of osteomyelitis, nasal carriage of MRSA, prior use of antibacterials or hospitalization, larger ulcer size and longer duration of the ulcer. The need for amputation and surgical debridement increases in patients infected with MRSA. Infections of mild or moderate severity caused by community-acquired MRSA can be treated with cotrimoxazole (trimethoprim/sulfamethoxazole), doxycycline or clindamycin when susceptibility results are available, while severe community-acquired or hospital-acquired MRSA infections should be managed with glycopeptides, linezolide or daptomycin. Dalbavancin, tigecycline and ceftobiprole are newer promising antimicrobial agents active against MRSA that may also have a role in the treatment of foot infections if more data on their efficacy and safety become available.

16 Review Comparison of community-acquired pneumonia due to methicillin-resistant and methicillin-susceptible Staphylococcus aureus producing the Panton-Valentine leukocidin. 2009

Vardakas, K Z / Matthaiou, D K / Falagas, M E. ·Alfa Institute of Biomedical Sciences, Athens, Greece. ·Int J Tuberc Lung Dis · Pubmed #19919764.

ABSTRACT: OBJECTIVE: To investigate the clinical features and prognosis of patients with methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-susceptible S. aureus (MSSA) community-acquired pneumonia (CAP) producing the Panton-Valentine leukocidin (PVL). METHODS: PubMed and Scopus were searched. Inclusion was stratified according to S. aureus susceptibility and clinical, microbiological and outcome data of patients with S. aureus CAP; both primary and secondary cases of CAP (hematogenous spread from other sites of infection) were included. RESULTS: We identified 71 articles reporting data on patients with MRSA (n = 76) and MSSA (n = 31) PVL-positive CAP. There were no differences in demographics and history among patients with MRSA and MSSA CAP. Features associated with MRSA CAP were gastrointestinal tract symptoms (P = 0.016) and unilobar infiltrates (P = 0.043). Features associated with MSSA CAP were airway hemorrhage (P = 0.01), multilobar infiltrates (P = 0.043) and acute respiratory distress syndrome (ARDS, P = 0.023). Although MSSA patients were more likely to receive initial appropriate antimicrobial therapy (P < 0.001), there was no difference in mortality between the two groups (P = 0.919). Univariate analysis showed that influenza-like symptoms (P < 0.001), multi-organ failure (P < 0.001), admission to the intensive care unit (P < 0.001), mechanical ventilation (P < 0.001), leucopenia (P < 0.001), shock (P = 0.001), development of complications (P = 0.003), vein thrombosis (P < 0.001), disseminated intravascular coagulation (P = 0.03), acidosis (P = 0.012), rash (P = 0.024), ARDS (P = 0.021), necrotizing pneumonia (P = 0.026), and use of macrolides after culture results (P = 0.011) were factors associated with death. CONCLUSIONS: Patients with MRSA PVL-positive CAP did not have higher rates of mortality than patients with MSSA PVL-positive CAP.

17 Review Do changes in antimicrobial resistance necessitate reconsideration of surgical antimicrobial prophylaxis strategies? 2009

Falagas, Matthew E / Alexiou, Vangelis G / Peppas, George / Makris, Gregory C. ·Alfa Institute of Biomedical Sciences (AIBS), Athens, Greece. m.falagas@aibs.gr ·Surg Infect (Larchmt) · Pubmed #19689199.

ABSTRACT: BACKGROUND: The potential need for re-evaluation of guidelines on surgical antimicrobial prophylaxis (AMP) in an era of advancing antimicrobial resistance is a matter of a considerable controversy. METHOD: Review of the pertinent literature. RESULTS: Over the last decade, the prevalence of methicillin-resistant Staphylococcus aureus (MRSA) has increased significantly, as illustrated by several surveillance studies. The blending of community acquisition and long-term carriage may increase the probability of unrecognized MRSA carriers being admitted to the hospital. Thus, MRSA is considered a major epidemiological threat in most parts of the world, exerting pressure for reconsideration of the guidelines for surgical AMP. The use of a glycopeptide as first-choice prophylaxis in major procedures such as cardiac surgery generally is not recommended but is not ruled out. Current recommendations are based on trials performed almost a decade ago at the latest and do not reflect the contemporary epidemiology of resistance. A few recent studies suggested that vancomycin in combination with gentamicin and rifampicin reduces the incidence of surgical site infections significantly in high-risk patients. These developments led some surgeons and infectious diseases clinicians to consider advanced antimicrobial coverage in surgical AMP. On the other hand, other clinicians are rightfully skeptical about extensive administration of glycopeptides or other agents beyond first- or second-generation cephalosporins because of the risk of further emergence and dissemination of antimicrobial resistance. CONCLUSION: Properly designed randomized trials are needed urgently to determine whether standard perioperative AMP should be reconsidered in settings with changing etiology of surgical infections.

18 Review Fosfomycin for the treatment of infections caused by Gram-positive cocci with advanced antimicrobial drug resistance: a review of microbiological, animal and clinical studies. 2009

Falagas, Matthew E / Roussos, Nikos / Gkegkes, Ioannis D / Rafailidis, Petros I / Karageorgopoulos, Drosos E. ·Alfa Institute of Biomedical Sciences (AIBS), 9 Neapoleos Street, 15123 Marousi, Athens, Greece. m.falagas@aibs.gr ·Expert Opin Investig Drugs · Pubmed #19548851.

ABSTRACT: BACKGROUND: The advancing antimicrobial drug resistance in Gram-positive cocci complicates the selection of appropriate therapy. The re-evaluation of older antibiotics may prove useful in expanding relevant therapeutic options. OBJECTIVE: We sought to evaluate fosfomycin for the treatment of infections caused by methicillin-resistant staphylococci, vancomycin-resistant enterococci, and penicillin-non-susceptible pneumococci. METHODS: We searched in PubMed, Scopus, and the Cochrane Library for studies evaluating the antimicrobial activity of fosfomycin against the above-mentioned pathogens, or the in vivo or clinical effectiveness of fosfomycin for the treatment of infections caused by these pathogens. RESULTS/CONCLUSIONS: As reported in the identified studies, the susceptibility rate of methicillin-resistant Staphylococcus aureus to fosfomycin was > or = 90% in 12/22, and 50-90% in 7/22 studies; the cumulative susceptibility rate was 87.9% (4240/4892 isolates). The cumulative susceptibility rate of vancomycin-resistant enterococci to fosfomycin was 30.3% (183/604 isolates), and that of penicillin-non-susceptible pneumococci was 87.2% (191/219 isolates). Clinical data show that fosfomycin, primarily in combination regimens, has been associated with clinical success in 28/29 (96.6%) cases of infection (mainly pneumonia, bacteremia, and meningitis) by fosfomycin-susceptible isolates of methicillin-resistant S. aureus. The above data support further research on the role of fosfomycin against infections caused by Gram-positive cocci with advanced antimicrobial drug resistance.

19 Article Successful nonsurgical therapy of a diabetic foot osteomyelitis in a patient with peripheral artery disease with almost complete radiological restoration. 2018

Loupa, C V / Meimeti, E / Voyatzoglou, E / Donou, A / Koutsantoniou, E / Lafoyanni, S. ·Demetrios Voyatzoglou Diabetic Foot Clinic, Amalia Fleming Hospital Unit, Athens, Greece. ch-loupa@hol.gr. · Demetrios Voyatzoglou Diabetic Foot Clinic, Amalia Fleming Hospital Unit, Athens, Greece. · Radiology Department, Amalia Fleming Hospital Unit, Athens, Greece. ·BMC Res Notes · Pubmed #30103808.

ABSTRACT: BACKGROUND: Diabetic foot ulcer (DFU) is a common complication in patients with diabetes mellitus (DM) and can consequently lead to soft tissue infection and osteomyelitis. CASE PRESENTATION: We present a case of a 68-year-old man with a history of Type 2 DM and symptomatic peripheral artery disease, referred to our hospital due to an infected lower extremity DFU. Cultures revealed methicillin-resistant Staphylococcus aureus and Stenotrophomonas maltophilia. There was a significant increase of inflammatory marker levels and plain X-rays revealed osteomyelitis. He underwent lower extremity angioplasty for the restoration of the blood flow. He received targeted intravenous antibiotic therapy for 2 weeks and continued ciprofloxacin along with clindamycin per os for 10 more weeks as outpatient. CONCLUSION: As a result, the patient presented almost complete healing of his DFU, reconstruction of osteomyelitis defects in X-ray and complete restoration of his foot functionality only 4 months after the end of the treatment. This case demonstrates a DFU complicated by osteomyelitis which resolved medically and nonsurgically, with the exception of surgical restoration of the blood flow.

20 Article Attaching the NorA Efflux Pump Inhibitor INF55 to Methylene Blue Enhances Antimicrobial Photodynamic Inactivation of Methicillin-Resistant Staphylococcus aureus in Vitro and in Vivo. 2017

Rineh, Ardeshir / Dolla, Naveen K / Ball, Anthony R / Magana, Maria / Bremner, John B / Hamblin, Michael R / Tegos, George P / Kelso, Michael J. ·Illawarra Health and Medical Research Institute and School of Chemistry, University of Wollongong , Northfields Ave., Wollongong, New South Wales 2522, Australia. · Gliese 623B , Lowell, Massachusetts 01852, United States. · Department of Biopathology and Clinical Microbiology, Athens Medical School, Aeginition Hospital , Athens 115 28, Greece. · The Wellman Center for Photomedicine, Massachusetts General Hospital , Boston, Massachusetts 02114, United States. · Department of Dermatology, Harvard Medical School , Boston, Massachusetts 02114, United States. · Harvard-MIT Division of Health Sciences and Technology , Cambridge, Massachusetts 02114, United States. ·ACS Infect Dis · Pubmed #28799332.

ABSTRACT: Antimicrobial photodynamic inactivation (aPDI) uses photosensitizers (PSs) and harmless visible light to generate reactive oxygen species (ROS) and kill microbes. Multidrug efflux systems can moderate the phototoxic effects of PSs by expelling the compounds from cells. We hypothesized that increasing intracellular concentrations of PSs by inhibiting efflux with a covalently attached efflux pump inhibitor (EPI) would enhance bacterial cell phototoxicity and reduce exposure of neighboring host cells to damaging ROS. In this study, we tested the hypothesis by linking NorA EPIs to methylene blue (MB) and examining the photoantimicrobial activity of the EPI-MB hybrids against the human pathogen methicillin-resistant Staphylococcus aureus (MRSA). Photochemical/photophysical and in vitro microbiological evaluation of 16 hybrids carrying four different NorA EPIs attached to MB via four linker types identified INF55-(Ac)en-MB 12 as a lead. Compound 12 showed increased uptake into S. aureus cells and enhanced aPDI activity and wound healing effects (relative to MB) in a murine model of an abrasion wound infected by MRSA. The study supports a new approach for treating localized multidrug-resistant MRSA infections and paves the way for wider exploration of the EPI-PS hybrid strategy in aPDI.

21 Article Efficacy of intramuscular moxifloxacin in the treatment of experimental osteomyelitis caused by methicillin-resistant Staphylococcus aureus. 2017

Soranoglou, Vasileios / Galanopoulos, Ilias / Giamarellos-Bourboulis, Evangelos J / Papalois, Apostolos / Giannitsioti, Efthymia / Poultsides, Lazaros A / Choreftaki, Theodosia / Kanellakopoulou, Kyriaki. ·2nd Department of Orthopaedics, 'G. Gennimatas' General Hospital, Athens, Greece. Electronic address: vassoran78@gmail.com. · 1st Department of Orthopaedics, 401 General Military Hospital, Athens, Greece. · 4th Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece. · ELPEN Pharmaceutical Company, Pikermi, Greece. · Adult Reconstruction and Joint Replacement Division, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA. · Department of Pathology, 'G. Gennimatas' Athens General Hospital, Athens, Greece. ·Int J Antimicrob Agents · Pubmed #28579454.

ABSTRACT: Fluoroquinolones have been well studied in the treatment of chronic osteomyelitis due to their beneficial pharmacokinetic (PK) and pharmacodynamic profiles. The purpose of this study was to determine the efficacy of intramuscular (IM) moxifloxacin administration in the treatment of experimental osteomyelitis by methicillin-resistant Staphylococcus aureus. Following an experimental osteomyelitis animal model described previously, three groups of rabbits (A = control; B = IM moxifloxacin administration; C = PK study of moxifloxacin penetration into bone) were evaluated. Three weeks after bacterial inoculation, surgical debridement was performed in all animals and IM treatment commenced for Groups B and C. Sacrifice was performed in an A:B group animal ratio of 1:2 at weekly intervals from 7th to 42nd day post debridement and from 21st to 56th day post debridement for Groups A and B, respectively (including 2-week interval without antibiotics for Group B). Cancellous bone was harvested for microbiological and histopathological analyses at re-operation and sacrifice for Groups A and B. Cortical bone moxifloxacin levels were measured in Group C following 7, 14, 35 and 42 days of treatment. In Group A, bacterial growth after surgical debridement was significant, whereas high eradication rates were observed in Group B. Radiological abnormalities and histopathological findings were evaluated. Moxifloxacin bone levels, observed in Group C, were approximately 43 times higher than the minimum inhibitory concentration, with no difference found between infected and healthy tibial bone. The therapeutic protocol was very effective in this model of experimental osteomyelitis. However, further evaluation of these results in clinical studies is crucial.

22 Article Disulfides with Anti-inflammatory Activity from the Brown Alga Dictyopteris membranacea. 2016

Dimou, Maria / Ioannou, Efstathia / Daskalaki, Maria G / Tziveleka, Leto A / Kampranis, Sotirios C / Roussis, Vassilios. ·Department of Pharmacognosy and Chemistry of Natural Products, Faculty of Pharmacy, School of Health Sciences, University of Athens , Panepistimiopolis Zografou, Athens 15771, Greece. · Department of Biochemistry, School of Medicine, University of Crete , P.O. Box 2208, Heraklion 71003, Greece. ·J Nat Prod · Pubmed #26943727.

ABSTRACT: Six new (1, 2, and 4-7) and two previously reported (3 and 8) disulfides, along with 4-butyl-2,6-cycloheptadienone, γ-tocopherol, and δ-tocopherol, were isolated from an organic extract of the brown alga Dictyopteris membranacea, collected at Gerolimenas Bay, Greece. The structure elucidation of the isolated natural products was based on analysis of their spectroscopic data. Compounds 1, 3-6, and 8 were evaluated for their antibacterial and anti-inflammatory activities. None of the compounds displayed antibacterial activity against two resistant strains of Staphylococcus aureus and one strain of Escherichia coli. In contrast, metabolite 5 was able to cause strong inhibition of NO production with an IC50 value of 3.8 μM using an LPS stimulation assay.

23 Article Nationwide surveillance of resistance rates of Staphylococcus aureus clinical isolates from Greek hospitals, 2012-2013. 2016

Souli, Maria / Karaiskos, Ilias / Galani, Lambrini / Maraki, Sofia / Perivolioti, Efstathia / Argyropoulou, Athina / Charissiadou, Athina / Zachariadou, Levantia / Tsiplakou, Sofia / Papaioannou, Vassiliki / Tsorlini, Helen / Katsifa, Helen / Baka, Vasiliki / Pantazi, Paraskevi / Paschali, Angeliki / Kyratsa, Anna / Trikka-Graphakos, Eleftheria / Giannopoulou, Panagiota / Vogiatzakis, Evangelos / Moraitou, Helen / Papadogeorgaki, Helen / Avgerinou, Helen / Panagea, Theofano / Pantazatou, Angeliki / Petinaki, Efthymia / Stamatopoulou, Giannoula / Toutouza, Marina / Karatzoglou, Ioanna / Kontopoulou, Konstantina / Orfanidou, Maria / Karantani, Irene / Fytas, Panteleimon / Tzanetou, Konstantina / Platsouka, Evangelia / Kazila, Polyzo / Chli, Anastasia / Statiri, Ntina / Giamarellou, Helen. ·a 4th Department of Internal Medicine , Athens University School of Medicine, University General Hospital 'Attikon' , Chaidari, Athens , Greece. · b 6th Department of Internal Medicine , Hygeia Hospital , Marousi, Athens , Greece. · c Department of Clinical Bacteriology, Parasitology, Zoonoses and Geographical Medicine , University Hospital of Heraklion , Heraklion , Crete. · d Department of Clinical Microbiology , Evaggelismos Hospital , Athens , Greece. · e Microbiology Department , 'Aghia Sophia' Children's Hospital , Athens , Greece. · f Microbiology Department , 'KAT' Hospital , Kifissia, Athens , Greece. · g Microbiological Laboratory, Bacteriology Department , 'G.Papanikolaou' General Hospital of Thessaloniki , Thessaloniki , Greece. · h Microbiology Department , 'Korgialenio-Benakio' Hellenic Red Cross Hospital , Athens , Greece. · i Microbiology Department , General Hospital of Corfu , Corfu , Greece. · j Department of Clinical Microbiology , 'Thriassio' General Hospital , Elefsina , Greece. · k Microbiology-Biochemistry Laboratory and National Reference Laboratory for Mycobacteria , 'Sotiria' Chest Diseases Hospital of Athens , Athens , Greece. · l Microbiology Department , 'A.Syggros' University Hospital for Skin and Venereal Diseases , Athens , Greece. · m Microbiology Department , Sismanogleio-A. Fleming General Hospital , Vrilissia, Athens , Greece. · n Department of Microbiology , 'Laikon' General Hospital , Athens , Greece. · o Department of Microbiology , University Hospital of Larissa , Larissa, Thessalia , Greece. · p Microbiology Laboratory , General Hospital of Xanthi , Xanthi, Thrace , Greece. · q Department of Microbiology , 'Hippokration' General Hospital of Athens , Athens , Greece. · r Department of Microbiology , General Hospital of Kavala , Kavala , Greece. · s Department of Microbiology , 'G. Gennimatas' General Hospital of Thessaloniki , Thessaloniki , Greece. · t Microbiology Laboratory , 'G. Gennimatas' General Hospital of Athens , Athens , Greece. · u Microbiology Laboratory , Hygeia Hospital , Marousi, Athens , Greece. · v Microbiology Laboratory , 'Agios Pavlos' General Hospital of Thessaloniki , Thessaloniki , Greece. · w Microbiology Department , 'Alexandra' General Hospital of Athens , Athens , Greece. · x Department of Microbiology , General Hospital of Nea Ionia-Konstantopouleio - Patision , Athens , Greece. · y Microbiology Department , 'Theageneio' Cancer Hospital of Thessaloniki , Thessaloniki , Greece. · z Laboratory of Microbiology , General Hospital of Drama , Drama , Greece. · aa Department of Microbiology , General Hospital of Rhodes , Rhodes , Greece. ·Infect Dis (Lond) · Pubmed #26635179.

ABSTRACT: Purpose To evaluate the in vitro efficacy of several anti-staphylococcal agents against a nationwide collection of contemporary Staphylococcus aureus clinical isolates from several healthcare centres in Greece. Methods Thirty hospitals throughout Greece (18 in Attica) provided all clinical isolates of S.aureus from April 2012 to May 2013 to a central lab to be re-submitted to susceptibility testing. The MICs were evaluated by Vitek® 2 with the exception of ceftaroline (OXOID M.I.C. Evaluator™). Vancomycin and daptomycin MICs were also evaluated by Etest®. Heterogeneously vancomycin-intermediate strains (hVISA) were detected by the Etest® GRD. VISA phenotype was confirmed by PAP-AUC. Results A total of 1005 isolates (39% MRSA) were studied. Susceptibility rates were: erythromycin 66.5%, clindamycin 79.2%, SXT 98.9%, rifampicin 97.3%, fusidic acid 67%, moxifloxacin 78.8%, vancomycin 99.9%, ceftaroline 92.9% and linezolid, tigecycline and daptomycin 100%. For mupirocin, high level resistance could be excluded for 98.9% of isolates. Vancomycin Etest® MIC

24 Article Assessment of the effect of a Salmonella enterica ser. Typhimurium culture supernatant on the single-cell lag time of foodborne pathogens. 2015

Blana, Vasiliki A / Lianou, Alexandra / Nychas, George-John E. ·Laboratory of Microbiology and Biotechnology of Foods, Department of Food Science and Human Nutrition, School of Food, Biotechnology and Development, Agricultural University of Athens, Athens 11855, Greece. · Laboratory of Microbiology and Biotechnology of Foods, Department of Food Science and Human Nutrition, School of Food, Biotechnology and Development, Agricultural University of Athens, Athens 11855, Greece. Electronic address: alianou@aua.gr. · Laboratory of Microbiology and Biotechnology of Foods, Department of Food Science and Human Nutrition, School of Food, Biotechnology and Development, Agricultural University of Athens, Athens 11855, Greece. Electronic address: gjn@aua.gr. ·Int J Food Microbiol · Pubmed #26433459.

ABSTRACT: The objective of this study was the in vitro evaluation of the effect of a cell-free microbial supernatant, produced by a luxS-positive Salmonella enterica ser. Typhimurium strain, on the single-cell growth kinetic behavior of two strains of S. enterica (serotypes Enteritidis and Typhimurium) and a methicillin-resistant Staphylococcus aureus strain. The single-cell lag time (λ) of the pathogens was estimated in the absence and presence (20% v/v) of microbial supernatant based on optical density measurements. As demonstrated by the obtained results, the tested microbial supernatant had a strain-specific effect on the single-cell λ and its variability. Although the mean λ values were similar in the absence and presence of microbial supernatant in the case of Salmonella Enteritidis, a significant (P ≤ 0.05) reduction and increase in the mean value of this parameter in the presence of microbial supernatant were observed for Salmonella Typhimurium and St. aureus, respectively. With regard to the effect of the tested microbial supernatant on the single-cell variability of λ, similar λ distributions were obtained in its absence and presence for S. Enteritidis, while considerable differences were noted for the other two tested organisms; the coefficient of variation of λ in the absence and presence of microbial supernatant was 41.6 and 69.8% for S. Typhimurium, respectively, with the corresponding values for St. aureus being 74.0 and 56.9%. As demonstrated by the results of bioassays, the tested microbial supernatant exhibited autoinducer-2 activity, indicating a potential association of such quorum sensing compounds with the observed effects. Although preliminary in nature, the collected data provide a good basis for future research on the role of quorum sensing in the single-cell growth behavior of foodborne pathogens.

25 Article Prevalence of Staphylococcus aureus and methicillin resistant Staphylococcus aureus (MRSA) in the oral cavity. 2015

Koukos, Georgios / Sakellari, Dimitra / Arsenakis, Minas / Tsalikis, Lazaros / Slini, Theodora / Konstantinidis, Antonios. ·251 General Air Force Hospital, Athens, Greece. Electronic address: gkoukos1977@gmail.com. · Department of Preventive Dentistry, Periodontology and Implant Biology, Dental School, Aristotle University of Thessaloniki, Greece. · Department of Genetics and Molecular Biology, School of Biology, Aristotle University of Thessaloniki, Greece. · Department of Mechanical Engineering, Aristotle University of Thessaloniki, Greece. ·Arch Oral Biol · Pubmed #26151200.

ABSTRACT: OBJECTIVE: To assess the prevalence of Staphylococcus aureus and methicillin resistant Staphylococcus aureus (MRSA) in plaque and tongue samples from systemically healthy subjects with periodontal health, gingivitis or chronic periodontitis. METHODS: After screening 720 potentially eligible subjects, 154 systemically healthy participants were ultimately enrolled in the current study. Subgingival samples were taken from the first molars and the tongue and analyzed for the presence of S. aureus and MRSA by polymerase chain reaction (PCR), using primers and conditions previously described in the literature. In addition, samples were taken from deep periodontal pockets of chronic periodontitis patients. Statistical analysis was performed by applying non-parametric tests (Kruskal-Wallis for clinical parameters, and z-test with Bonferroni corrections for distributions of assessed parameters). All comparisons were set at the 0.05 significance level. RESULTS: S. aureus was detected in 18% of all participants and in 10% of the samples tested. No significant differences were found in its distribution among the three investigated groups (z-test for proportions with Bonferroni corrections, p>0.05). The mecA gene was not present in any of the S. aureus found. CONCLUSIONS: S. aureus can be found in the oral environment regardless of the periodontal conditions and therefore should be considered as a member of the transient flora not participating in periodontal pathology. Subgingival sites and tongue surfaces seem to be an unusual habitat of MRSA.