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Published on: February 19, 2019
Molecular Study of Accessory-Gene-Regulator in Staphylococcus aureus Isolated from Sepsis in Pediatric Patients
Insights
Pediatric sepsis caused by Staphylococcus aureus shows increased biofilm formation, particularly in Methicillin-resistant S. aureus (MRSA). The agr group I gene was predominant in MRSA and linked to biofilm production.
Area of Science:
- Microbiology
- Infectious Diseases
- Pediatrics
Background:
- Pediatric sepsis from Staphylococcus aureus presents significant morbidity and mortality.
- The Accessory-Gene-Regulator (agr) system influences S. aureus virulence gene expression.
- Understanding agr genotypes is crucial for pediatric sepsis management.
Purpose of the Study:
- Investigate the prevalence of agr genotypes in S. aureus from pediatric sepsis cases.
- Assess the relationship between agr genotypes, biofilm formation, and antibiotic resistance.
- Determine the role of agr in the pathogenesis of pediatric S. aureus sepsis.
Main Methods:
- Retrospective cross-sectional study of 131 pediatric sepsis cases due to S. aureus.
- Biofilm formation assessed using the microplate method.
- Antibiotic susceptibility determined by disc diffusion; agr genotypes identified via PCR.
Main Results:
- Methicillin-resistant S. aureus (MRSA) identified in 53.4% of isolates; 58% formed biofilms.
- agr group I was the most prevalent genotype (41.2%), particularly in MRSA.
- MRSA showed significantly higher biofilm formation (65.7%) and a strong association with agr I (68.6%) compared to MSSA.
Conclusions:
- Biofilm formation is increased in S. aureus from pediatric sepsis, with higher rates in MRSA.
- agr group I is the predominant genotype in pediatric S. aureus sepsis isolates.
- agr I is significantly associated with MRSA and enhanced biofilm formation in pediatric sepsis.
Background:
Pediatric sepsis due to Staphylococcus aureus (S. aureus) is associated with high morbidity and mortality. Accessory-Gene-Regulator (agr) has a role in the pathogenesis of S. aureus through controlling and regulating the expression of virulence genes. Therefore, the aim of the present study was to investigate the prevalence of genotypes of the agr system in S. aureus isolated from children with sepsis and to assess their relationship to biofilm formation and antibiotic resistance.
Methods:
The study was a retrograde cross-sectional study that included 131 children with health care associated sepsis due to S. aureus. The isolated S. aureus was investigated for their ability to form biofilm by microplate method, antibiotic susceptibility pattern by disc diffusion method, and molecular determination of agr genotypes by polymerase chain reaction (PCR).
Results:
Methicillin resistant S. aureus (MRSA) was defined by resistance to cefoxitin antibiotic disc in 70 (53.4%) of the isolates and biofilm formation was positive in 67 (58%) of the isolates. Molecular study of the agr genes revealed that 54 (41.2%), 40 (30.5%), 27 (20.6%), and 10 (7.5%) of the studied isolates had agr I, agr II, agr III, and agr IV, respectively. In comparison between MRSA and methicillin sensitive S. aureus (MSSA), there was a signif-icant increase in biofilm formation among MRSA (65.7%, p = 0.01) compared to MSSA (34.3%) and an increase in agr genotype I among MRSA (68.6%, p = 0.001) compared to agr I in MSSA (9.8%). There was a significant association with the presence of a central venous catheter (51.4%, p = 0.001) and urinary tract catheter (81.4%, p = 0.001) in children with MRSA compared to children with MSSA (21.3%, OR = 3.9, 95% CI = 1.8 - 8.5 and 36.1%, OR = 7.8, 95% CI 3.5 - 17.3, respectively).
Conclusions:
There was an increase in the biofilm formation among S. aureus isolated from pediatric patients with sepsis with a significant increase in MRSA. The agr group I was the main agr gene among the isolated S. aureus. Moreover, agr I was the predominant gene in MRSA isolates and was significantly associated with biofilm formation.
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