Central line-associated bloodstream infection and application of high resolution melting to methicillin resistant Staphylococcus aureus and Shigella sonnei genotyping

Effective infection prevention and control hospital program is essential for prevention hospital associated infections (HAIs). Central line-associated bloodstream infection (CLABSI) is one of the major threating patients in intensive care units (ICUs). However, CLABSIs can be prevented through proper prevention measures and guidelines information resources are free available in many national and international professional health agencies.

Methicillin resistant Staphylococcus aureus (MRSA) is a major bacterial agent that causing community-and-hospital associated (CA/HA) infections and related to significant morbidity and mortality rates worldwide. Shigellosis is a highly infectious disease threating public health, especially with Shigella sonnei species in developed and developing countries. These two microorganisms have ability to develop resistance to many available antimicrobial agents and consequence successfully cloned and distributed globally.

In 2011, the annual risk assessment of King Abdul Aziz Specialist hospital in Taif of Saudi Arabia has reported high incidence rate of CLABSI and the characteristic susceptibility patterns of community associated methicillin resistant Staphylococcus aureus (CA-MRSA) infections is different from the other locality in Saudi Arabia (data not published).

High-resolution melting (HRM) has been used for MRSA spa typing in clinical diagnostic laboratories for epidemiological purposes as accurate, rapid and cost effective scheme method. Rotor gene 6000-system is excellent fully equipped for real-time amplification for HRMA. It is possible to introduce a hypothesis of HRM is accrete and rapid of MRSA spa-typing and S. sonnei genotyping method for epidemiological purposes.

The hospital CLABSI prevention project was analyzed and extended to assess the susceptibility pattern, genotyping and virulence gene detection of MRSA infections in Saudi Arabia. Also, we tested the hypothesis of HRM genotyping by evaluating HRM of MRSA spa typing and identification of S. sonnei lineages and sub lineages using Rotor gene 6000-system among globally collected samples.

There was about 60% reduction of CLABSIs after implementation of Society for Healthcare Epidemiology of America/Infectious Diseases Society of America (SHEA/IDSA) practice guidelines. HRM can distinguishable identification of MRSA spa types as well as S. sonnei lineages and sub lineages. Most of MRSA spa types were unambiguously typed. All S. sonnei lineages and sub lineages were identified using HRM real-time PCR. Also, the reproducibility was assessed and results revealed the same. We observed high prevalence of panton valentine leukocidine (PVL) positive related to hospital associated MRSA infections (HA-MRSA) is Saudi Arabia.

The basic SHEA/IDSA practice recommendation is an effective prevention model for the reduction of CLABSI in the ICU. HRM-based is reproducible, simple, rapid and cost-effective for spa-typing and S. sonnei genotyping method. Emerging multi drug resistance S. aureus strains with PVL gene circulating within hospitals alarms the urgent need for continuous active surveillance and implementation prevention measures.

List of scientific papers

I. Waleed Mazi, Zikra Begum, Diaa Abdullah, Ahmed Hesham, Sami Maghari, Abdullah Assiri and Abiola Senok. Central line-associated bloodstream infection in a trauma intensive care unit: Impact of implementation of Society for Healthcare Epidemiology of America/Infectious Diseases Society of America practice guidelines. American Journal of Infection Control, 2014; 42:865-7.
https://doi.org/10.1016/j.ajic.2014.05.005

II. Waleed Mazi, Jun Yu, Gunnar Sandström and Amir Saeed. Emerging PVLpositive and multidrug-resistant Staphylococcus aureus in hospitalassociated infections in Taif, Saudi Arabia. [Manuscript]

III. Waleed Mazi, Vartul Sangal, Gunnar Sandström, Amir Saeed and Jun Yu. Evaluation of spa-typing of methicillin–resistant Staphylococcus aureus using high-resolution melting analysis. International Journal of Infectious Diseases, 2015; 38: 125-8.
https://doi.org/10.1016/j.ijid.2015.05.002

IV. Waleed Mazi, Vartul Sangal, Amir Saeed, Gunnar Sandström, Francois-Xavier Weill and Jun Yu. Rapid genotyping of Shigella sonnei by use of multiplex high-resolution melting. Journal of Clinical Microbiology, 2015;53:2389-1.
https://doi.org/10.1128/JCM.00874-15