Clinical and Molecular Epidemiology of Infective Endocarditis in Intravenous Drug Users

Pei Jiuan Chao, Chih Ho Hsu, Yung Ching Liu, Cheng Len Sy, Yao Shen Chen, Shue Ren Wann, Susan Shin Jung Lee, Hung Chin Tsai

Research output: Contribution to journalArticle

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Abstract

Background: Infective endocarditis (IE) in intravenous drug users has been increasing in incidence. The major pathogen used to be methicillin-susceptible Staphylococcus aureus, but resistant isolates have also been increasing. This study aimed to investigate the clinical characteristics of IE in intravenous drug users and to evaluate the molecular patterns of methicillin-resistant S. aureus (MRSA) that cause IE in these drug users. Methods: A total of 37 episodes of IE in intravenous drug users hospitalized from 1980 to 2006 at a 1,250-bed teaching hospital in Southern Taiwan were evaluated retrospectively. The genetic relatedness of S. aureus strains was assessed using pulsed-field gel electrophoresis. Polymerase chain reaction was used to detect Panton-Valentine leukocidin (PVL) and staphylococcal γ-hemolysin (Hlg), and to determine the staphylococcal chromosomal cassette carrying the mecA methicillin-resistant gene (SCCmec) type. Results: The patients had a mean ± standard deviation age of 31.5 ± 9.25 years, with a male predominance of 76%. Hepatitis C was present in all patients. Methicillin-susceptible S. aureus accounted for 76% of infections, and the most common clinical symptoms were fever (97%) and embolic phenomenon (68%). There were 4 MRSA isolates, 3 of which were SCCmec type III. PVL and Hlg genes were found in 2 and 3 MRSA isolates, respectively. Eighty percent similarity was found among the MRSA isolates by pulsed-field gel electrophoresis. Conclusion: Our results suggest that coinfection with hepatitis C was common in intravenous drug users with IE, and that molecular patterns of MRSA isolates had high similarity. SCCmec type III, which is usually hospital-acquired, could have caused the community-associated MRSA endocarditis in our patients.

Original languageEnglish
Pages (from-to)629-633
Number of pages5
JournalJournal of the Chinese Medical Association
Volume72
Issue number12
DOIs
Publication statusPublished - Dec 2009

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Molecular Epidemiology
Methicillin-Resistant Staphylococcus aureus
Drug Users
Endocarditis
Pulsed Field Gel Electrophoresis
Hepatitis C
Staphylococcus aureus
Hemolysin Proteins
Methicillin Resistance
Methicillin
Coinfection
Taiwan
Teaching Hospitals
Genes
Fever
Polymerase Chain Reaction
Incidence
Infection

Keywords

  • bacterial endocarditis
  • intravenous drug abuse
  • methicillin-resistant Staphylococcus aureus

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Clinical and Molecular Epidemiology of Infective Endocarditis in Intravenous Drug Users. / Chao, Pei Jiuan; Hsu, Chih Ho; Liu, Yung Ching; Sy, Cheng Len; Chen, Yao Shen; Wann, Shue Ren; Lee, Susan Shin Jung; Tsai, Hung Chin.

In: Journal of the Chinese Medical Association, Vol. 72, No. 12, 12.2009, p. 629-633.

Research output: Contribution to journalArticle

Chao, Pei Jiuan ; Hsu, Chih Ho ; Liu, Yung Ching ; Sy, Cheng Len ; Chen, Yao Shen ; Wann, Shue Ren ; Lee, Susan Shin Jung ; Tsai, Hung Chin. / Clinical and Molecular Epidemiology of Infective Endocarditis in Intravenous Drug Users. In: Journal of the Chinese Medical Association. 2009 ; Vol. 72, No. 12. pp. 629-633.
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abstract = "Background: Infective endocarditis (IE) in intravenous drug users has been increasing in incidence. The major pathogen used to be methicillin-susceptible Staphylococcus aureus, but resistant isolates have also been increasing. This study aimed to investigate the clinical characteristics of IE in intravenous drug users and to evaluate the molecular patterns of methicillin-resistant S. aureus (MRSA) that cause IE in these drug users. Methods: A total of 37 episodes of IE in intravenous drug users hospitalized from 1980 to 2006 at a 1,250-bed teaching hospital in Southern Taiwan were evaluated retrospectively. The genetic relatedness of S. aureus strains was assessed using pulsed-field gel electrophoresis. Polymerase chain reaction was used to detect Panton-Valentine leukocidin (PVL) and staphylococcal γ-hemolysin (Hlg), and to determine the staphylococcal chromosomal cassette carrying the mecA methicillin-resistant gene (SCCmec) type. Results: The patients had a mean ± standard deviation age of 31.5 ± 9.25 years, with a male predominance of 76{\%}. Hepatitis C was present in all patients. Methicillin-susceptible S. aureus accounted for 76{\%} of infections, and the most common clinical symptoms were fever (97{\%}) and embolic phenomenon (68{\%}). There were 4 MRSA isolates, 3 of which were SCCmec type III. PVL and Hlg genes were found in 2 and 3 MRSA isolates, respectively. Eighty percent similarity was found among the MRSA isolates by pulsed-field gel electrophoresis. Conclusion: Our results suggest that coinfection with hepatitis C was common in intravenous drug users with IE, and that molecular patterns of MRSA isolates had high similarity. SCCmec type III, which is usually hospital-acquired, could have caused the community-associated MRSA endocarditis in our patients.",
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AB - Background: Infective endocarditis (IE) in intravenous drug users has been increasing in incidence. The major pathogen used to be methicillin-susceptible Staphylococcus aureus, but resistant isolates have also been increasing. This study aimed to investigate the clinical characteristics of IE in intravenous drug users and to evaluate the molecular patterns of methicillin-resistant S. aureus (MRSA) that cause IE in these drug users. Methods: A total of 37 episodes of IE in intravenous drug users hospitalized from 1980 to 2006 at a 1,250-bed teaching hospital in Southern Taiwan were evaluated retrospectively. The genetic relatedness of S. aureus strains was assessed using pulsed-field gel electrophoresis. Polymerase chain reaction was used to detect Panton-Valentine leukocidin (PVL) and staphylococcal γ-hemolysin (Hlg), and to determine the staphylococcal chromosomal cassette carrying the mecA methicillin-resistant gene (SCCmec) type. Results: The patients had a mean ± standard deviation age of 31.5 ± 9.25 years, with a male predominance of 76%. Hepatitis C was present in all patients. Methicillin-susceptible S. aureus accounted for 76% of infections, and the most common clinical symptoms were fever (97%) and embolic phenomenon (68%). There were 4 MRSA isolates, 3 of which were SCCmec type III. PVL and Hlg genes were found in 2 and 3 MRSA isolates, respectively. Eighty percent similarity was found among the MRSA isolates by pulsed-field gel electrophoresis. Conclusion: Our results suggest that coinfection with hepatitis C was common in intravenous drug users with IE, and that molecular patterns of MRSA isolates had high similarity. SCCmec type III, which is usually hospital-acquired, could have caused the community-associated MRSA endocarditis in our patients.

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