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Jiang JH, Cameron DR, Nethercott C, Aires-de-Sousa M, Peleg AY. Virulence attributes of successful methicillin-resistant Staphylococcus aureus lineages. Clin Microbiol Rev 2023; 36:e0014822. [PMID: 37982596 PMCID: PMC10732075 DOI: 10.1128/cmr.00148-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2023] Open
Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) is a leading cause of severe and often fatal infections. MRSA epidemics have occurred in waves, whereby a previously successful lineage has been replaced by a more fit and better adapted lineage. Selection pressures in both hospital and community settings are not uniform across the globe, which has resulted in geographically distinct epidemiology. This review focuses on the mechanisms that trigger the establishment and maintenance of current, dominant MRSA lineages across the globe. While the important role of antibiotic resistance will be mentioned throughout, factors which influence the capacity of S. aureus to colonize and cause disease within a host will be the primary focus of this review. We show that while MRSA possesses a diverse arsenal of toxins including alpha-toxin, the success of a lineage involves more than just producing toxins that damage the host. Success is often attributed to the acquisition or loss of genetic elements involved in colonization and niche adaptation such as the arginine catabolic mobile element, as well as the activity of regulatory systems, and shift metabolism accordingly (e.g., the accessory genome regulator, agr). Understanding exactly how specific MRSA clones cause prolonged epidemics may reveal targets for therapies, whereby both core (e.g., the alpha toxin) and acquired virulence factors (e.g., the Panton-Valentine leukocidin) may be nullified using anti-virulence strategies.
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Affiliation(s)
- Jhih-Hang Jiang
- Department of Microbiology, Infection Program, Monash Biomedicine Discovery Institute, Monash University, Clayton, Victoria, Australia
- Department of Infectious Diseases, The Alfred Hospital and Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - David R. Cameron
- Department of Biomedical Research, University of Bern, Bern, Switzerland
| | - Cara Nethercott
- Department of Microbiology, Infection Program, Monash Biomedicine Discovery Institute, Monash University, Clayton, Victoria, Australia
| | - Marta Aires-de-Sousa
- Laboratory of Molecular Genetics, Institutode Tecnologia Químicae Biológica António Xavier (ITQB-NOVA), Universidade Nova de Lisboa, Oeiras, Portugal
- Escola Superior de Saúde da Cruz Vermelha Portuguesa-Lisboa (ESSCVP-Lisboa), Lisbon, Portugal
| | - Anton Y. Peleg
- Department of Microbiology, Infection Program, Monash Biomedicine Discovery Institute, Monash University, Clayton, Victoria, Australia
- Department of Infectious Diseases, The Alfred Hospital and Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Centre to Impact Antimicrobial Resistance, Monash University, Clayton, Melbourne, Victoria, Australia
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2
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Merialdi G, Feltrin F, Gaetarelli B, Lombardi G, Iurescia M, Alba P, Luppi A, Martinelli N, Ramini M, Carfora V, Franco A, Battisti A. Livestock-associated methicillin-resistant Staphylococcus aureus (LA-MRSA) spa type t127, Sequence Type (ST)1, quickly spreads and persists among young pigs. Pathog Dis 2020; 77:5524362. [PMID: 31247637 DOI: 10.1093/femspd/ftz033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Accepted: 06/26/2019] [Indexed: 11/14/2022] Open
Abstract
Livestock-associated methicillin-resistant Staphylococcus aureus (LA-MRSA) clones other than Clonal Complex (CC)398, as CC1, have been isolated in pigs in some countries, and appeared to be prevalent in Italy. The aim of this study was to evaluate the capability of Sequence Type (ST)1, CC1, LA-MRSA clone to colonize and to be transmitted among piglets. Eighteen caesarean-derived/colostrum-deprived piglets of 35 days of age were assigned randomly to three groups: four seeder piglets were contaminated with a spa type t127, ST1, SCCmec V, MRSA (Group A), 10 MRSA-negative piglets were exposed to Group A after 2 days post-contamination, dpc (Group B) and 4 piglets were used as control group (Group C). Piglets were evaluated until 44 dpc (Group A) or at 42 days post-exposure, dpe (Group B) and then euthanized and necropsied. All nasal and skin cultures of Group A resulted MRSA-positive throughout the experiment starting from two dpc, while Group C tested always MRSA-negative. At first sampling, all Group B piglets became positive and remained positive throughout the experiment. This is the first colonization/transmission study with a CC1 LA-MRSA in pigs. The results add further knowledge on the ability of CC1 LA-MRSA to colonize pigs, and on colonization/transmission patterns, both suggesting good host adaptation.
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Affiliation(s)
- Giuseppe Merialdi
- Istituto Zooprofilattico Sperimentale della Lombardia e dell'Emilia Romagna "Bruno Ubertini", Bologna Unit, Via Pietro Fiorini, 5, 40127, Bologna, Italy
| | - Fabiola Feltrin
- Istituto Zooprofilattico Sperimentale del Lazio e della Toscana "M. Aleandri", Department of General Diagnostics, National Reference Laboratory for Antimicrobial Resistance, Via Appia Nuova, 1411, 00178, Rome, Italy
| | - Barbara Gaetarelli
- Istituto Zooprofilattico Sperimentale della Lombardia e dell'Emilia Romagna "Bruno Ubertini", Sede Centrale di Brescia, Department of Laboratory Animals, Via Bianchi, 9, 25124, Brescia, Italy
| | - Guerino Lombardi
- Istituto Zooprofilattico Sperimentale della Lombardia e dell'Emilia Romagna "Bruno Ubertini", Sede Centrale di Brescia, Department of Laboratory Animals, Via Bianchi, 9, 25124, Brescia, Italy
| | - Manuela Iurescia
- Istituto Zooprofilattico Sperimentale del Lazio e della Toscana "M. Aleandri", Department of General Diagnostics, National Reference Laboratory for Antimicrobial Resistance, Via Appia Nuova, 1411, 00178, Rome, Italy
| | - Patricia Alba
- Istituto Zooprofilattico Sperimentale del Lazio e della Toscana "M. Aleandri", Department of General Diagnostics, National Reference Laboratory for Antimicrobial Resistance, Via Appia Nuova, 1411, 00178, Rome, Italy
| | - Andrea Luppi
- Istituto Zooprofilattico Sperimentale della Lombardia e dell'Emilia Romagna "Bruno Ubertini", Parma Unit, Strada dei Mercati, 13A, 43126, Parma, Italy
| | - Nicola Martinelli
- Istituto Zooprofilattico Sperimentale della Lombardia e dell'Emilia Romagna "Bruno Ubertini", Sede Centrale di Brescia, Department of Laboratory Animals, Via Bianchi, 9, 25124, Brescia, Italy
| | - Mattia Ramini
- Istituto Zooprofilattico Sperimentale della Lombardia e dell'Emilia Romagna "Bruno Ubertini", Bologna Unit, Via Pietro Fiorini, 5, 40127, Bologna, Italy
| | - Virginia Carfora
- Istituto Zooprofilattico Sperimentale del Lazio e della Toscana "M. Aleandri", Department of General Diagnostics, National Reference Laboratory for Antimicrobial Resistance, Via Appia Nuova, 1411, 00178, Rome, Italy
| | - Alessia Franco
- Istituto Zooprofilattico Sperimentale del Lazio e della Toscana "M. Aleandri", Department of General Diagnostics, National Reference Laboratory for Antimicrobial Resistance, Via Appia Nuova, 1411, 00178, Rome, Italy
| | - Antonio Battisti
- Istituto Zooprofilattico Sperimentale del Lazio e della Toscana "M. Aleandri", Department of General Diagnostics, National Reference Laboratory for Antimicrobial Resistance, Via Appia Nuova, 1411, 00178, Rome, Italy
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3
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Rosen K, Roesler U, Merle R, Friese A. Persistent and Transient Airborne MRSA Colonization of Piglets in a Newly Established Animal Model. Front Microbiol 2018; 9:1542. [PMID: 30057576 PMCID: PMC6053491 DOI: 10.3389/fmicb.2018.01542] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 06/20/2018] [Indexed: 12/16/2022] Open
Abstract
Livestock-associated methicillin-resistant Staphylococcus aureus (LA-MRSA) was first found in 2005 and is up to date widespread in animal husbandry reservoir – focusing on pig farming. The regular detectability of MRSA in the air of pigsties as well as in exhaust air of pig farms (mean count: 102 cfu/m3) poses the question whether an airborne spread and, therefore, a MRSA colonization of animals via the airborne route exists. To answer this question, we exposed three groups of nine MRSA-negative tested piglets each to a defined airborne MRSA concentration (102, 104, and 106 cfu/m3) in our aerosol chamber for 24 h. In the following observation period of 21 days, the MRSA status of the piglets was monitored by taking different swab samples (nasal, pharyngeal, skin, conjunctival, and rectal swab). At the end of the experiment, we euthanized the piglets and investigated different tissues and organs for the spread of MRSA. The data of our study imply the presence of an airborne MRSA colonization route: the animals exposed to 106 cfu/m3 MRSA in the air were persistent colonized. The piglets exposed to an airborne MRSA concentration of 104 cfu/m3 were transient, and the piglets exposed to an airborne MRSA concentration of 102 cfu/m3 were not colonized. Consequently, a colonization via the airborne route was proven.
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Affiliation(s)
- Kerstin Rosen
- Institute for Animal Hygiene and Environmental Health, Freie Universität Berlin, Berlin, Germany
| | - Uwe Roesler
- Institute for Animal Hygiene and Environmental Health, Freie Universität Berlin, Berlin, Germany
| | - Roswitha Merle
- Institute for Veterinary Epidemiology and Biostatistics, Freie Universität Berlin, Berlin, Germany
| | - Anika Friese
- Institute for Animal Hygiene and Environmental Health, Freie Universität Berlin, Berlin, Germany
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4
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Slingerland BCGC, Keehnen M, Ouwerling B, Tavakol M, Snijders SV, Verbrugh HA, Vos MC, Remarque EJ, Langermans JAM, van Wamel WJB. An experimental Staphylococcus aureus carriage and decolonization model in rhesus macaques (Macaca mulatta). PLoS One 2018; 13:e0194718. [PMID: 29649257 PMCID: PMC5896908 DOI: 10.1371/journal.pone.0194718] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2017] [Accepted: 03/08/2018] [Indexed: 11/18/2022] Open
Abstract
Our human model of nasal colonization and eradication of S. aureus is limited by safety issues. As rhesus macaques are closely related to humans and natural hosts for S. aureus, we developed an experimental decolonization and inoculation protocol in these animals. Animals were screened for nasal carriage of S. aureus and 20 carriers were selected. Decolonization was attempted using nasal mupirocin (10 animals) or mupirocin plus trimethoprim/sulfadiazine intramuscularly (10 animals) both once daily for 5 days, and checked by follow-up cultures for 10 weeks. Intranasal inoculation was performed with S. aureus strain 8325–4 in culture-negative animals. 11/20 animals, of which 5 received mupirocin and 6 the combination treatment, became culture-negative for S. aureus for 10 weeks and these 11 animals were subsequently inoculated. Swabs were taken once a week for 5 weeks to test for the presence of the inoculated strain. In 3 animals, strain 8325–4 was cultured from the nose 1 week after inoculation, indicating short-term survival of this strain only, a finding similar to that previously found in our human model. These data demonstrate that rhesus macaques may constitute a relevant animal model to perform S. aureus eradication and inoculation studies with relatively limited invasive handling of the animals.
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Affiliation(s)
- Bibi C. G. C. Slingerland
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC, Rotterdam, The Netherlands
- * E-mail:
| | - Merei Keehnen
- Animal Science Department, Biomedical Primate Research Centre, Rijswijk, The Netherlands
| | - Boudewijn Ouwerling
- Animal Science Department, Biomedical Primate Research Centre, Rijswijk, The Netherlands
| | - Mehri Tavakol
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC, Rotterdam, The Netherlands
| | - Susan V. Snijders
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC, Rotterdam, The Netherlands
| | - Henri A. Verbrugh
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC, Rotterdam, The Netherlands
| | - Margreet C. Vos
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC, Rotterdam, The Netherlands
| | - Edmond J. Remarque
- Department of Virology, Biomedical Primate Research Centre, Rijswijk, The Netherlands
| | - Jan A. M. Langermans
- Animal Science Department, Biomedical Primate Research Centre, Rijswijk, The Netherlands
| | - Willem J. B. van Wamel
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC, Rotterdam, The Netherlands
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5
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Flaxman A, van Diemen PM, Yamaguchi Y, Allen E, Lindemann C, Rollier CS, Milicic A, Wyllie DH. Development of persistent gastrointestinal S. aureus carriage in mice. Sci Rep 2017; 7:12415. [PMID: 28963555 PMCID: PMC5622074 DOI: 10.1038/s41598-017-12576-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Accepted: 09/01/2017] [Indexed: 01/09/2023] Open
Abstract
One fifth to one quarter of the human population is asymptomatically, naturally and persistently colonised by Staphylococcus aureus. Observational human studies indicate that although the whole population is intermittently exposed, some individuals lose S. aureus rapidly. Others become persistent carriers, as assessed by nasal cultures, with many individuals colonised for decades. Current animal models of S. aureus colonisation are expensive and normally require antibiotics. Importantly, these animal models have not yet contributed to our poor understanding of the dichotomy in human colonisation status. Here, we identify a single strain of S. aureus found to be persistently colonising the gastrointestinal tract of BALB/c mice. Phylogenetic analyses suggest it diverged from a human ST15 lineage in the recent past. We show that murine carriage of this organism occurs in the bowel and nares, is acquired early in life, and can persist for months. Importantly, we observe the development of persistent and non-persistent gastrointestinal carriage states in genetically identical mice. We developed a needle- and antibiotic-free model in which we readily induced S. aureus colonisation of the gastrointestinal tract experimentally by environmental exposure. Using our experimental model, impact of adaptive immunity on S. aureus colonisation could be assessed. Vaccine efficacy to eliminate colonisation could also be investigated using this model.
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Affiliation(s)
- Amy Flaxman
- Jenner Institute, University of Oxford, The Henry Wellcome Building for Molecular Physiology, Oxford, UK
| | - Pauline M van Diemen
- Jenner Institute, University of Oxford, The Henry Wellcome Building for Molecular Physiology, Oxford, UK
| | - Yuko Yamaguchi
- Jenner Institute, University of Oxford, The Henry Wellcome Building for Molecular Physiology, Oxford, UK
| | - Elizabeth Allen
- Jenner Institute, University of Oxford, The Henry Wellcome Building for Molecular Physiology, Oxford, UK
| | - Claudia Lindemann
- Jenner Institute, University of Oxford, The Henry Wellcome Building for Molecular Physiology, Oxford, UK
| | - Christine S Rollier
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, CCVTM, Oxford, UK.,The NIHR Oxford Biomedical Research Centre, Oxford University Hospitals, Oxford, UK
| | | | - David H Wyllie
- Jenner Institute, University of Oxford, The Henry Wellcome Building for Molecular Physiology, Oxford, UK.
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6
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Mutters NT, Bieber CP, Hauck C, Reiner G, Malek V, Frank U. Comparison of livestock-associated and health care-associated MRSA-genes, virulence, and resistance. Diagn Microbiol Infect Dis 2016; 86:417-421. [PMID: 27640079 DOI: 10.1016/j.diagmicrobio.2016.08.016] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Revised: 08/17/2016] [Accepted: 08/22/2016] [Indexed: 12/17/2022]
Abstract
Livestock-associated methicillin-resistant Staphylococcus aureus (LA-MRSA) may colonize and infect humans with close contact to pigs. We compared phenotypic and genotypic differences in resistance and virulence of LA-MRSA isolates from farms and farmers with hospital-acquired methicillin-resistant S. aureus (HA-MRSA) and assessed carriage rates. Samples from pigs (n=330), occupationally exposed personnel (n=63), the farm environment (n=134), and hospital patients (n=220) were obtained. Approximately 50% (166/330) of pigs were MRSA positive. All LA-MRSA were resistant to tetracycline, compared to only 8% of HA-MRSA (P<0.001). In contrast, HA-MRSA isolates showed significantly higher resistance rates to quinolones (81% versus 7%; P<0.001). All strains isolated from occupationally exposed personnel (61.9%; 39/63) belonged to CC398. HA-MRSA isolates were diversely distributed, with predominance of CC5 (62.7%). Human strains carried significantly more virulence genes than porcine strains, especially exotoxins (P<0.001) and immune-evasion cluster genes (P<0.001). There were significant differences in resistance patterns and recognized genotypic virulence loci between LA-MRSA and HA-MRSA.
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Affiliation(s)
- Nico T Mutters
- Department of Infectious Diseases, Heidelberg University Hospital, Im Neuenheimer Feld 324, 69120 Heidelberg, Germany.
| | - Christian P Bieber
- Department of Infectious Diseases, Heidelberg University Hospital, Im Neuenheimer Feld 324, 69120 Heidelberg, Germany; Department for Veterinary Clinical Sciences, Justus-Liebig-University Gießen, Frankfurter Straße 112 D-35392 Gießen, Germany
| | - Catherine Hauck
- Department of Infectious Diseases, Heidelberg University Hospital, Im Neuenheimer Feld 324, 69120 Heidelberg, Germany; Department for Veterinary Clinical Sciences, Justus-Liebig-University Gießen, Frankfurter Straße 112 D-35392 Gießen, Germany
| | - Gerald Reiner
- Department for Veterinary Clinical Sciences, Justus-Liebig-University Gießen, Frankfurter Straße 112 D-35392 Gießen, Germany
| | - Veronika Malek
- Department of Infectious Diseases, Heidelberg University Hospital, Im Neuenheimer Feld 324, 69120 Heidelberg, Germany
| | - Uwe Frank
- Department of Infectious Diseases, Heidelberg University Hospital, Im Neuenheimer Feld 324, 69120 Heidelberg, Germany
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Verstappen KM, Tulinski P, Duim B, Fluit AC, Carney J, van Nes A, Wagenaar JA. The Effectiveness of Bacteriophages against Methicillin-Resistant Staphylococcus aureus ST398 Nasal Colonization in Pigs. PLoS One 2016; 11:e0160242. [PMID: 27487020 PMCID: PMC4972443 DOI: 10.1371/journal.pone.0160242] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Accepted: 07/15/2016] [Indexed: 12/02/2022] Open
Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) is an important colonizer in animals and an opportunistic pathogen in humans. In humans, MRSA can cause infections that might be difficult to treat because of antimicrobial resistance. The use of bacteriophages has been suggested as a potential approach for the control of MRSA colonization to minimize the—often occupational—exposure of humans. The aim of this study was to assess the efficacy of bacteriophage treatment on porcine nasal colonization with MRSA in vitro, in vivo, and ex vivo. The effectiveness of a bacteriophage combination of phage K*710 and P68 was assessed in vitro by incubating them with MRSA V0608892/1 (ST398) measuring the OD600 hourly. To study the in vivo effect, bacteriophages were administered in a gel developed for human application, which contain 109 plaque-forming units (pfu)/mL (K and P68 in a 19.25:1 ratio) for 5 days to piglets (N = 8) that were experimentally colonized with the MRSA strain. Eight piglets experimentally colonized were used as a negative control. The MRSA strain was also used to colonize porcine nasal mucosa explants and bacteriophages were applied to assess the ex vivo efficacy of treatment. Bacteriophages were effective in vitro. In vivo, sixteen piglets were colonized with MRSA but the number of CFU recovered after the application of the bacteriophages in 8 piglets was not reduced compared to the control animals (approx. 105 CFU/swab). In the ex vivo model, 108 CFU were used to establish colonization with MRSA; a reduction of colonization was not observed after application of bacteriophages. However, application of mupirocin both in vivo and ex vivo resulted in a near eradication of MRSA. In conclusion: i) The MRSA strain was killed in the presence of the bacteriophages phage K*710 and P68 in vitro. ii) Bacteriophages did not reduce porcine nasal colonization in vivo or ex vivo. Physiological in vivo and ex vivo conditions may explain these observations. Efficacy in the ex vivo model matched that of the in vivo system.
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Affiliation(s)
- Koen M Verstappen
- Department of Infectious Diseases and Immunology, Faculty of Veterinary Medicine, Utrecht University, Utrecht, the Netherlands
| | - Pawel Tulinski
- Department of Infectious Diseases and Immunology, Faculty of Veterinary Medicine, Utrecht University, Utrecht, the Netherlands
| | - Birgitta Duim
- Department of Infectious Diseases and Immunology, Faculty of Veterinary Medicine, Utrecht University, Utrecht, the Netherlands
- * E-mail:
| | - Ad C Fluit
- Department of Medical Microbiology, University Medical Centre Utrecht, Utrecht, the Netherlands
| | | | - Arie van Nes
- Department of Farm Animal Health, Faculty of Veterinary Medicine, Utrecht University, Utrecht, the Netherlands
| | - Jaap A Wagenaar
- Department of Infectious Diseases and Immunology, Faculty of Veterinary Medicine, Utrecht University, Utrecht, the Netherlands
- Central Veterinary Institute of Wageningen UR, Lelystad, the Netherlands
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