1
|
Fayolle M, Morsli M, Gelis A, Chateauraynaud M, Yahiaoui-Martinez A, Sotto A, Lavigne JP, Dunyach-Remy C. The Persistence of Staphylococcus aureus in Pressure Ulcers: A Colonising Role. Genes (Basel) 2021; 12:1883. [PMID: 34946833 PMCID: PMC8701790 DOI: 10.3390/genes12121883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Revised: 11/19/2021] [Accepted: 11/22/2021] [Indexed: 11/17/2022] Open
Abstract
Decubitus pressure ulcers (PU) are a major complication of immobilised patients. Staphylococcus aureus is one of the most frequently detected microorganisms in PU samples; however, its persistence and role in the evolution of these wounds is unknown. In this study, we analysed S. aureus strains isolated from PU biopsies at inclusion and day 28. Eleven S. aureus (21.1%) were detected in 52 patients at inclusion. Only six PUs (11.5%) continued to harbour this bacterium at day 28. Using a whole genome sequencing approach (Miseq®, Illumina), we confirmed that these six S. aureus samples isolated at D28 were the same strain as that isolated at inclusion, with less than 83 bp difference. Phenotypical studies evaluating the growth profiles (Infinite M Mano, Tecan®) and biofilm formation (Biofilm Ring Test®) did not detect any significant difference in the fitness of the pairs of S. aureus. However, using the Caenorhabditis elegans killing assay, a clear decrease of virulence was observed between strains isolated at D28 compared with those isolated at inclusion, regardless of the clinical evolution of the PU. Moreover, all strains at inclusion were less virulent than a control S. aureus strain, i.e., NSA739. An analysis of polymicrobial communities of PU (by metabarcoding approach), in which S. aureus persisted, demonstrated no impact of Staphylococcus genus on PU evolution. Our study suggested that S. aureus presented a colonising profile on PU with no influence on wound evolution.
Collapse
Affiliation(s)
- Martin Fayolle
- Virulence Bactérienne et Infections Chroniques, INSERM U1047, Université de Montpellier, Service de Microbiologie et Hygiène Hospitalière, CHU Nîmes, 30908 Nîmes, France; (M.F.); (A.Y.-M.); (C.D.-R.)
| | - Madjid Morsli
- IRD, Microbes, Evolution, Phylogeny and Infection (MEPHI), Aix-Marseille-Université, IHU Méditerranée Infection, 13005 Marseille, France;
| | - Anthony Gelis
- Centre Mutualiste Neurologique Propara, 34090 Montpellier, France;
| | - Marion Chateauraynaud
- Virulence Bactérienne et Infections Chroniques, INSERM U1047, Université de Montpellier, 30908 Nîmes, France;
| | - Alex Yahiaoui-Martinez
- Virulence Bactérienne et Infections Chroniques, INSERM U1047, Université de Montpellier, Service de Microbiologie et Hygiène Hospitalière, CHU Nîmes, 30908 Nîmes, France; (M.F.); (A.Y.-M.); (C.D.-R.)
| | - Albert Sotto
- Virulence Bactérienne et Infections Chroniques, INSERM U1047, Université de Montpellier, Service de Maladies Infectieuses et Tropicales, CHU Nîmes, 30908 Nîmes, France;
| | - Jean-Philippe Lavigne
- Virulence Bactérienne et Infections Chroniques, INSERM U1047, Université de Montpellier, Service de Microbiologie et Hygiène Hospitalière, CHU Nîmes, 30908 Nîmes, France; (M.F.); (A.Y.-M.); (C.D.-R.)
| | - Catherine Dunyach-Remy
- Virulence Bactérienne et Infections Chroniques, INSERM U1047, Université de Montpellier, Service de Microbiologie et Hygiène Hospitalière, CHU Nîmes, 30908 Nîmes, France; (M.F.); (A.Y.-M.); (C.D.-R.)
| |
Collapse
|
2
|
Knox J, Uhlemann AC, Lowy FD. Stopping household MRSA transmission and recurrent infections: an unmet challenge. Clin Infect Dis 2020; 73:e4578-e4580. [PMID: 32520349 DOI: 10.1093/cid/ciaa745] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 06/05/2020] [Indexed: 11/14/2022] Open
Affiliation(s)
- Justin Knox
- Department of Epidemiology, Columbia University, New York, New York, USA
| | - Anne-Catrin Uhlemann
- Division of Infectious Diseases, Department of Medicine, Columbia University, College of Physicians and Surgeons, New York, New York, USA
| | - Franklin D Lowy
- Division of Infectious Diseases, Department of Medicine, Columbia University, College of Physicians and Surgeons, New York, New York, USA
- Department of Pathology and Cell Biology, Columbia University, College of Physicians and Surgeons, New York, New York, USA
| |
Collapse
|
3
|
Monecke S, Syed MA, Khan MA, Ahmed S, Tabassum S, Gawlik D, Müller E, Reissig A, Braun SD, Ehricht R. Genotyping of methicillin-resistant Staphylococcus aureus from sepsis patients in Pakistan and detection of antibodies against staphylococcal virulence factors. Eur J Clin Microbiol Infect Dis 2019; 39:85-92. [PMID: 31482419 DOI: 10.1007/s10096-019-03695-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 08/28/2019] [Indexed: 05/15/2023]
Abstract
In order to obtain more information on the MRSA population structure in the border region of Afghanistan and Pakistan, we collected and genotyped MRSA causing bloodstream infections from a tertiary care hospital in Peshawar, Pakistan, that serves the local population as well as Afghan immigrants and refugees. Thirty-one MRSA isolates from 30 patients were included and characterized by microarray hybridisation. For 25 patients, serum samples were tested using protein microarrays in order to detect antibodies against staphylococcal virulence factors. The most conspicuous result was the high rate of PVL-positive MRSA. Twenty-two isolates (71%) harboured lukF/S-PV genes. The most common lineage was CC772-MRSA-V/VT (PVL+) to which eleven isolates were assigned. The second most common strain was, surprisingly, CC8-MRSA-[IV+ACME] (PVL+), "USA300" (9 isolates). Two isolates were tst1 positive CC22-MRSA-IV, matching the Middle Eastern "Gaza Epidemic Strain". Another two were PVL-positive CC30-MRSA-IV. The remaining isolates belonged to, possibly locally emerging, CC1, CC5, and CC8 strains with SCC mec IV elements. Twenty-three patient sera were positive for anti-PVL-IgG antibodies. Several questions arise from the present study. It can be assumed that MRSA and high rates of PVL-positive S. aureus/MRSA are a public health issue in the Afghanistan/Pakistan border region. A possible emergence of the "USA300" clone as well as of the CC772 lineage warrants further investigation.
Collapse
Affiliation(s)
- Stefan Monecke
- Leibniz Institute of Photonic Technology (IPHT), Jena, Germany. .,InfectoGnostics Research Campus Jena, Jena, Germany. .,Institute for Medical Microbiology and Hygiene, Medical Faculty "Carl Gustav Carus", Technische Universität Dresden, Dresden, Germany.
| | - Muhammad Ali Syed
- Department of Microbiology, The University of Haripur, Haripur, Pakistan
| | - Mushtaq Ahmad Khan
- Department of Microbiology, Hazara University Mansehra, Mansehra, Pakistan
| | - Shehzad Ahmed
- Department of Microbiology, Hazara University Mansehra, Mansehra, Pakistan
| | - Sadia Tabassum
- Department of Zoology, Hazara University Mansehra, Mansehra, Pakistan
| | | | - Elke Müller
- Leibniz Institute of Photonic Technology (IPHT), Jena, Germany.,InfectoGnostics Research Campus Jena, Jena, Germany
| | - Annett Reissig
- Leibniz Institute of Photonic Technology (IPHT), Jena, Germany.,InfectoGnostics Research Campus Jena, Jena, Germany
| | - Sascha D Braun
- Leibniz Institute of Photonic Technology (IPHT), Jena, Germany.,InfectoGnostics Research Campus Jena, Jena, Germany
| | - Ralf Ehricht
- Leibniz Institute of Photonic Technology (IPHT), Jena, Germany.,InfectoGnostics Research Campus Jena, Jena, Germany
| |
Collapse
|
4
|
Pereira MR, Rana MM. Methicillin-resistant Staphylococcus aureus in solid organ transplantation-Guidelines from the American Society of Transplantation Infectious Diseases Community of Practice. Clin Transplant 2019; 33:e13611. [PMID: 31120612 DOI: 10.1111/ctr.13611] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 05/20/2019] [Indexed: 12/25/2022]
Abstract
These updated guidelines from the American Society of Transplantation Infectious Diseases Community of Practice review the epidemiology, diagnosis, prevention, and management of methicillin-resistant Staphylococcus aureus (MRSA) infections in solid organ transplantation. Despite an increasing armamentarium of antimicrobials active against MRSA, improved diagnostic tools, and overall declining rates of infection, MRSA infections remain a substantial cause of morbidity and mortality in solid organ transplant recipients. Pre- and post-transplant MRSA colonization is a significant risk factor for post-transplant MRSA infection. The preferred initial treatment of MRSA bacteremia remains vancomycin. Hand hygiene, chlorhexidine bathing in the ICU, central-line bundles that focus on reducing unnecessary catheter use, disinfection of patient equipment, and the environment along with antimicrobial stewardship are all aspects of an infection prevention approach to prevent MRSA transmission and decrease healthcare-associated infections.
Collapse
|
5
|
Genetic Determinants of High-Level Oxacillin Resistance in Methicillin-Resistant Staphylococcus aureus. Antimicrob Agents Chemother 2018; 62:AAC.00206-18. [PMID: 29555636 DOI: 10.1128/aac.00206-18] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 03/11/2018] [Indexed: 12/20/2022] Open
Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) strains carry either a mecA- or a mecC-mediated mechanism of resistance to beta-lactam antibiotics, and the phenotypic expression of resistance shows extensive strain-to-strain variation. In recent communications, we identified the genetic determinants associated with the stringent stress response that play a major role in the antibiotic resistant phenotype of the historically earliest "archaic" clone of MRSA and in the mecC-carrying MRSA strain LGA251. Here, we sought to test whether or not the same genetic determinants also contribute to the resistant phenotype of highly and homogeneously resistant (H*R) derivatives of a major contemporary MRSA clone, USA300. We found that the resistance phenotype was linked to six genes (fruB, gmk, hpt, purB, prsA, and relA), which were most frequently targeted among the analyzed 20 H*R strains (one mutation per clone in 19 of the 20 H*R strains). Besides the strong parallels with our previous findings (five of the six genes matched), all but one of the repeatedly targeted genes were found to be linked to guanine metabolism, pointing to the key role that this pathway plays in defining the level of antibiotic resistance independent of the clonal type of MRSA.
Collapse
|
6
|
Millar EV, Rice GK, Elassal EM, Schlett CD, Bennett JW, Redden CL, Mor D, Law NN, Tribble DR, Hamilton T, Ellis MW, Bishop-Lilly KA. Genomic Characterization of USA300 Methicillin-Resistant Staphylococcus aureus (MRSA) to Evaluate Intraclass Transmission and Recurrence of Skin and Soft Tissue Infection (SSTI) Among High-Risk Military Trainees. Clin Infect Dis 2017; 65:461-468. [PMID: 28419202 PMCID: PMC5849051 DOI: 10.1093/cid/cix327] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Accepted: 04/10/2017] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Military trainees are at increased risk for methicillin-resistant Staphylococcus aureus (MRSA) skin and soft tissue infection (SSTI). Whole genome sequencing (WGS) can refine our understanding of MRSA transmission and microevolution in congregate settings. METHODS We conducted a prospective case-control study of SSTI among US Army infantry trainees at Fort Benning, Georgia, from July 2012 to December 2014. We identified clusters of USA300 MRSA SSTI within select training classes and performed WGS on clinical isolates. We then linked genomic, phylogenetic, epidemiologic, and clinical data in order to evaluate intra- and interclass disease transmission. Furthermore, among cases of recurrent MRSA SSTI, we evaluated the intrahost relatedness of infecting strains. RESULTS Nine training classes with ≥5 cases of USA300 MRSA SSTI were selected. Eighty USA300 MRSA clinical isolates from 74 trainees, 6 (8.1%) of whom had recurrent infection, were subjected to WGS. We identified 2719 single nucleotide variants (SNVs). The overall median (range) SNV difference between isolates was 173 (1-339). Intraclass median SNV differences ranged from 23 to 245. Two phylogenetic clusters were suggestive of interclass MRSA transmission. One of these clusters stemmed from 2 classes that were separated by a 13-month period but housed in the same barracks. Among trainees with recurrent MRSA SSTI, the intrahost median SNV difference was 7.5 (1-48). CONCLUSIONS Application of WGS revealed intra- and interclass transmission of MRSA among military trainees. An interclass cluster between 2 noncontemporaneous classes suggests a long-term reservoir for MRSA in this setting.
Collapse
Affiliation(s)
- Eugene V Millar
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Rockville
| | - Gregory K Rice
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Rockville
- Naval Medical Research Center, Biological Defense Research Directorate, Fort Detrick
| | - Emad M Elassal
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Rockville
| | - Carey D Schlett
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Rockville
| | - Jason W Bennett
- Walter Reed Army Institute of Research, Silver Spring
- Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Cassie L Redden
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Rockville
- Naval Medical Research Center, Biological Defense Research Directorate, Fort Detrick
| | - Deepika Mor
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Rockville
| | - Natasha N Law
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Rockville
- Martin Army Community Hospital, Fort Benning, Georgia
| | - David R Tribble
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda
| | - Theron Hamilton
- Naval Medical Research Center, Biological Defense Research Directorate, Fort Detrick
| | - Michael W Ellis
- University of Toledo College of Medicine and Life Sciences, Ohio
| | - Kimberly A Bishop-Lilly
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Rockville
- Naval Medical Research Center, Biological Defense Research Directorate, Fort Detrick
| |
Collapse
|
7
|
Lee GC, Hall RG, Boyd NK, Dallas SD, Du LC, Treviño LB, Treviño SB, Retzloff C, Lawson KA, Wilson J, Olsen RJ, Wang Y, Frei CR. A prospective observational cohort study in primary care practices to identify factors associated with treatment failure in Staphylococcus aureus skin and soft tissue infections. Ann Clin Microbiol Antimicrob 2016; 15:58. [PMID: 27876059 PMCID: PMC5120512 DOI: 10.1186/s12941-016-0175-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Accepted: 11/18/2016] [Indexed: 12/21/2022] Open
Abstract
Background The incidence of outpatient visits for skin and soft tissue infections (SSTIs) has substantially increased over the last decade. The emergence of community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) has made the management of S. aureus SSTIs complex and challenging. The objective of this study was to identify risk factors contributing to treatment failures associated with community-associated S. aureus skin and soft tissue infections SSTIs. Methods This was a prospective, observational study among 14 primary care clinics within the South Texas Ambulatory Research Network. The primary outcome was treatment failure within 90 days of the initial visit. Univariate associations between the explanatory variables and treatment failure were examined. A generalized linear mixed-effect model was developed to identify independent risk factors associated with treatment failure. Results Overall, 21% (22/106) patients with S. aureus SSTIs experienced treatment failure. The occurrence of treatment failure was similar among patients with methicillin-resistant S. aureus and those with methicillin-susceptible S. aureus SSTIs (19 vs. 24%; p = 0.70). Independent predictors of treatment failure among cases with S. aureus SSTIs was a duration of infection of ≥7 days prior to initial visit [aOR, 6.02 (95% CI 1.74–19.61)] and a lesion diameter size ≥5 cm [5.25 (1.58–17.20)]. Conclusions Predictors for treatment failure included a duration of infection for ≥7 days prior to the initial visit and a wound diameter of ≥5 cm. A heightened awareness of these risk factors could help direct targeted interventions in high-risk populations.
Collapse
Affiliation(s)
- Grace C Lee
- College of Pharmacy, University of Texas at Austin, Austin, TX, USA. .,Pharmacotherapy Education and Research Center, School of Medicine, The University of Texas Health Science Center, 7703 Floyd Curl Dr, MC 6220, San Antonio, TX, 78229-3900, USA.
| | - Ronald G Hall
- School of Pharmacy, Texas Tech University Health Sciences Center, Dallas, TX, USA.,Dose Optimization and Outcomes Research (DOOR) Program, Dallas, TX, USA
| | - Natalie K Boyd
- College of Pharmacy, University of Texas at Austin, Austin, TX, USA.,Pharmacotherapy Education and Research Center, School of Medicine, The University of Texas Health Science Center, 7703 Floyd Curl Dr, MC 6220, San Antonio, TX, 78229-3900, USA
| | - Steven D Dallas
- Department of Clinical Laboratory Sciences, School of Health Professions, University of Texas Health Science Center, San Antonio, TX, USA
| | - Liem C Du
- South Texas Ambulatory Research Network, The University of Texas Health Science Center, San Antonio, TX, USA
| | - Lucina B Treviño
- South Texas Ambulatory Research Network, The University of Texas Health Science Center, San Antonio, TX, USA
| | - Sylvia B Treviño
- South Texas Ambulatory Research Network, The University of Texas Health Science Center, San Antonio, TX, USA
| | - Chad Retzloff
- South Texas Ambulatory Research Network, The University of Texas Health Science Center, San Antonio, TX, USA
| | - Kenneth A Lawson
- College of Pharmacy, University of Texas at Austin, Austin, TX, USA
| | - James Wilson
- College of Pharmacy, University of Texas at Austin, Austin, TX, USA
| | - Randall J Olsen
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital and Research Institute, Houston, TX, USA
| | - Yufeng Wang
- Department of Biology, The University of Texas San Antonio, San Antonio, TX, USA
| | - Christopher R Frei
- College of Pharmacy, University of Texas at Austin, Austin, TX, USA.,Pharmacotherapy Education and Research Center, School of Medicine, The University of Texas Health Science Center, 7703 Floyd Curl Dr, MC 6220, San Antonio, TX, 78229-3900, USA
| |
Collapse
|
8
|
Mehraj J, Witte W, Akmatov MK, Layer F, Werner G, Krause G. Epidemiology of Staphylococcus aureus Nasal Carriage Patterns in the Community. Curr Top Microbiol Immunol 2016; 398:55-87. [PMID: 27370344 DOI: 10.1007/82_2016_497] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/08/2022]
Abstract
Staphylococcus aureus (S. aureus) is a Gram-positive opportunistic pathogen that colonizes frequently and asymptomatically the anterior nares of humans and animals. It can cause different kinds of infections and is considered to be an important nosocomial pathogen. Nasal carriage of S. aureus can be permanent or intermittent and may build the reservoir for autogenous infections and cross-transmission to other individuals. Most of the studies on the epidemiology of S. aureus performed in the past were focused on the emergence and dissemination of methicillin-resistant Staphylococcus aureus (MRSA) in healthcare settings. There are, however, a number of more recent epidemiological studies have aimed at analysing carriage patterns over time in the community settings providing new insights on risk factors for colonization and important data for the development of strategies to prevent infections. This chapter aims to give a review of current epidemiological studies on S. aureus carriage patterns in the general community and put them into perspective with recent, yet unpublished, investigations on the S. aureus epidemiology in the general population in northern Germany.
Collapse
Affiliation(s)
- Jaishri Mehraj
- Department of Epidemiology, Helmholtz Centre for Infection Research, Inhoffenstraße 7, 38124, Brunswick, Germany.,Hannover Medical School, Hannover, Germany
| | - Wolfgang Witte
- The Robert Koch Institute, Wernigerode Branch, Wernigerode, Germany
| | - Manas K Akmatov
- Department of Epidemiology, Helmholtz Centre for Infection Research, Inhoffenstraße 7, 38124, Brunswick, Germany.,TWINCORE Centre for Experimental and Clinical Infection Research, Hannover, Germany
| | - Franziska Layer
- The Robert Koch Institute, Wernigerode Branch, Wernigerode, Germany
| | - Guido Werner
- The Robert Koch Institute, Wernigerode Branch, Wernigerode, Germany
| | - Gérard Krause
- Department of Epidemiology, Helmholtz Centre for Infection Research, Inhoffenstraße 7, 38124, Brunswick, Germany. .,Hannover Medical School, Hannover, Germany.
| |
Collapse
|
9
|
Methicillin-Resistant Staphylococcus aureus USA300 Latin American Variant in Patients Undergoing Hemodialysis and HIV Infected in a Hospital in Bogotá, Colombia. PLoS One 2015; 10:e0140748. [PMID: 26474075 PMCID: PMC4608721 DOI: 10.1371/journal.pone.0140748] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Accepted: 09/30/2015] [Indexed: 02/04/2023] Open
Abstract
We aimed to determine the prevalence of MRSA colonization and examine the molecular characteristics of colonizing isolates in patients receiving hemodialysis and HIV-infected in a Colombian hospital. Patients on hemodialysis and HIV-infected were prospectively followed between July 2011 and June 2012 in Bogota, Colombia. Nasal and axillary swabs were obtained and cultured. Colonizing S. aureus isolates were identified by standard and molecular techniques. Molecular typing was performed by using pulse-field gel electrophoresis and evaluating the presence of lukF-PV/lukS-PV by PCR. A total of 29% (n = 82) of HIV-infected and 45.5% (n = 15) of patients on hemodialysis exhibited S. aureus colonization. MSSA/MRSA colonization was observed in 28% and 3.6% of the HIV patients, respectively and in 42.4% and 13.3% of the hemodialysis patients, respectively. Staphylococcal cassette chromosome mec typing showed that four MRSA isolates harbored the type IV cassette, and one type I. In the hemodialysis group, two MRSA isolates were classified as belonging to the USA300-LV genetic lineage. Conversely, in the HIV infected group, no colonizing isolates belonging to the USA300-Latin American Variant (UDA300-LV) lineage were identified. Colonizing isolates recovered from the HIV-infected group belonged to the prevalent hospital-associated clones circulating in Latin America (Chilean [n = 1] and Pediatric [n = 2]). The prevalence of MRSA colonization in the study groups was 3.6% (HIV) and 13.3% (hemodialysis). Surveillance programs should be implemented in this group of patients in order to understand the dynamics of colonization and infection in high-risk patients.
Collapse
|
10
|
Gaviria-Agudelo C, Aroh C, Tareen N, Wakeland EK, Kim M, Copley LA. Genomic Heterogeneity of Methicillin Resistant Staphylococcus aureus Associated with Variation in Severity of Illness among Children with Acute Hematogenous Osteomyelitis. PLoS One 2015; 10:e0130415. [PMID: 26086671 PMCID: PMC4473274 DOI: 10.1371/journal.pone.0130415] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Accepted: 05/20/2015] [Indexed: 11/23/2022] Open
Abstract
Introduction The association between severity of illness of children with osteomyelitis caused by Methicillin-resistant Staphylococcus aureus (MRSA) and genomic variation of the causative organism has not been previously investigated. The purpose of this study is to assess genomic heterogeneity among MRSA isolates from children with osteomyelitis who have diverse severity of illness. Materials and Methods Children with osteomyelitis were prospectively studied between 2010 and 2011. Severity of illness of the affected children was determined from clinical and laboratory parameters. MRSA isolates were analyzed with next generation sequencing (NGS) and optical mapping. Sequence data was used for multi-locus sequence typing (MLST), phylogenetic analysis by maximum likelihood (PAML), and identification of virulence genes and single nucleotide polymorphisms (SNP) relative to reference strains. Results The twelve children studied demonstrated severity of illness scores ranging from 0 (mild) to 9 (severe). All isolates were USA300, ST 8, SCC mec IVa MRSA by MLST. The isolates differed from reference strains by 2 insertions (40 Kb each) and 2 deletions (10 and 25 Kb) but had no rearrangements or copy number variations. There was a higher occurrence of virulence genes among study isolates when compared to the reference strains (p = 0.0124). There were an average of 11 nonsynonymous SNPs per strain. PAML demonstrated heterogeneity of study isolates from each other and from the reference strains. Discussion Genomic heterogeneity exists among MRSA isolates causing osteomyelitis among children in a single community. These variations may play a role in the pathogenesis of variation in clinical severity among these children.
Collapse
Affiliation(s)
- Claudia Gaviria-Agudelo
- Department of Pediatric Infectious Disease, University of Texas Southwestern Medical Center, Dallas, Texas, United States of America
| | - Chukwuemika Aroh
- Department of Immunology, University of Texas Southwestern Medical Center, Dallas, Texas, United States of America
| | - Naureen Tareen
- Children’s Medical Center, Dallas, Texas, United States of America
| | - Edward K. Wakeland
- Department of Immunology, University of Texas Southwestern Medical Center, Dallas, Texas, United States of America
| | - MinSoo Kim
- Department of Biomedical Informatics, University of Texas Southwestern Medical Center, Dallas, TX, United States of America
| | - Lawson A. Copley
- Children’s Medical Center, Dallas, Texas, United States of America
- Texas Scottish Rite Hospital for Children, Dallas, Texas, United States of America
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, United States of America
- * E-mail:
| |
Collapse
|
11
|
Planet PJ, Diaz L, Kolokotronis SO, Narechania A, Reyes J, Xing G, Rincon S, Smith H, Panesso D, Ryan C, Smith DP, Guzman M, Zurita J, Sebra R, Deikus G, Nolan RL, Tenover FC, Weinstock GM, Robinson DA, Arias CA. Parallel Epidemics of Community-Associated Methicillin-Resistant Staphylococcus aureus USA300 Infection in North and South America. J Infect Dis 2015; 212:1874-82. [PMID: 26048971 DOI: 10.1093/infdis/jiv320] [Citation(s) in RCA: 87] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Accepted: 05/13/2015] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND The community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) epidemic in the United States is attributed to the spread of the USA300 clone. An epidemic of CA-MRSA closely related to USA300 has occurred in northern South America (USA300 Latin-American variant, USA300-LV). Using phylogenomic analysis, we aimed to understand the relationships between these 2 epidemics. METHODS We sequenced the genomes of 51 MRSA clinical isolates collected between 1999 and 2012 from the United States, Colombia, Venezuela, and Ecuador. Phylogenetic analysis was used to infer the relationships and times since the divergence of the major clades. RESULTS Phylogenetic analyses revealed 2 dominant clades that segregated by geographical region, had a putative common ancestor in 1975, and originated in 1989, in North America, and in 1985, in South America. Emergence of these parallel epidemics coincides with the independent acquisition of the arginine catabolic mobile element (ACME) in North American isolates and a novel copper and mercury resistance (COMER) mobile element in South American isolates. CONCLUSIONS Our results reveal the existence of 2 parallel USA300 epidemics that shared a recent common ancestor. The simultaneous rapid dissemination of these 2 epidemic clades suggests the presence of shared, potentially convergent adaptations that enhance fitness and ability to spread.
Collapse
Affiliation(s)
- Paul J Planet
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Columbia University, College of Physicians and Surgeons Sackler Institute for Comparative Genomics, American Museum of Natural History
| | - Lorena Diaz
- Molecular Genetics and Antimicrobial Resistance Unit, International Center for Microbial Genomics, Universidad El Bosque, Bogotá, Colombia
| | - Sergios-Orestis Kolokotronis
- Sackler Institute for Comparative Genomics, American Museum of Natural History Department of Biological Sciences, Fordham University, Bronx, New York
| | - Apurva Narechania
- Sackler Institute for Comparative Genomics, American Museum of Natural History
| | - Jinnethe Reyes
- Molecular Genetics and Antimicrobial Resistance Unit, International Center for Microbial Genomics, Universidad El Bosque, Bogotá, Colombia
| | - Galen Xing
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Columbia University, College of Physicians and Surgeons
| | - Sandra Rincon
- Molecular Genetics and Antimicrobial Resistance Unit, International Center for Microbial Genomics, Universidad El Bosque, Bogotá, Colombia
| | - Hannah Smith
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Columbia University, College of Physicians and Surgeons
| | - Diana Panesso
- Division of Infectious Diseases, Department of Internal Medicine Molecular Genetics and Antimicrobial Resistance Unit, International Center for Microbial Genomics, Universidad El Bosque, Bogotá, Colombia
| | - Chanelle Ryan
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Columbia University, College of Physicians and Surgeons
| | - Dylan P Smith
- Molecular Genetics and Antimicrobial Resistance Unit, International Center for Microbial Genomics, Universidad El Bosque, Bogotá, Colombia
| | | | - Jeannete Zurita
- Hospital Vozandes, Pontificia Universidad Catolica, Quito, Ecuador
| | - Robert Sebra
- Genome Center, Mount Sinai Hospital, New York City
| | | | - Rathel L Nolan
- Division of Infectious Diseases, Department of Internal Medicine
| | | | | | - D Ashley Robinson
- Division of Infectious Diseases, Department of Microbiology, University of Mississippi Medical Center, Jackson
| | - Cesar A Arias
- Division of Infectious Diseases, Department of Internal Medicine Department of Microbiology and Molecular Genetics, University of Texas Medical School at Houston Molecular Genetics and Antimicrobial Resistance Unit, International Center for Microbial Genomics, Universidad El Bosque, Bogotá, Colombia
| |
Collapse
|
12
|
Knox J, Uhlemann AC, Lowy FD. Staphylococcus aureus infections: transmission within households and the community. Trends Microbiol 2015; 23:437-44. [PMID: 25864883 DOI: 10.1016/j.tim.2015.03.007] [Citation(s) in RCA: 87] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Revised: 03/09/2015] [Accepted: 03/13/2015] [Indexed: 02/07/2023]
Abstract
Staphylococcus aureus, both methicillin susceptible and resistant, are now major community-based pathogens worldwide. The basis for this is multifactorial and includes the emergence of epidemic clones with enhanced virulence, antibiotic resistance, colonization potential, or transmissibility. Household reservoirs of these unique strains are crucial to their success as community-based pathogens. Staphylococci become resident in households, either as colonizers or environmental contaminants, increasing the risk for recurrent infections. Interactions of household members with others in different households or at community sites, including schools and daycare facilities, have a critical role in the ability of these strains to become endemic. Colonization density at these sites appears to have an important role in facilitating transmission. The integration of research tools, including whole-genome sequencing (WGS), mathematical modeling, and social network analysis, has provided additional insight into the transmission dynamics of these strains. Thus far, interventions designed to reduce recurrent infections among household members have had limited success, likely due to the multiplicity of potential sources for recolonization. The development of better strategies to reduce the number of household-based infections will depend on greater insight into the different factors that contribute to the success of these uniquely successful epidemic clones of S. aureus.
Collapse
Affiliation(s)
- Justin Knox
- Division of Infectious Diseases, Department of Medicine, Columbia University, College of Physicians & Surgeons, New York, NY, USA
| | - Anne-Catrin Uhlemann
- Division of Infectious Diseases, Department of Medicine, Columbia University, College of Physicians & Surgeons, New York, NY, USA
| | - Franklin D Lowy
- Division of Infectious Diseases, Department of Medicine, Columbia University, College of Physicians & Surgeons, New York, NY, USA; Department of Pathology & Cell Biology, Columbia University, College of Physicians & Surgeons, NY, NY, USA.
| |
Collapse
|
13
|
Transmission and microevolution of USA300 MRSA in U.S. households: evidence from whole-genome sequencing. mBio 2015; 6:e00054. [PMID: 25759497 PMCID: PMC4453535 DOI: 10.1128/mbio.00054-15] [Citation(s) in RCA: 75] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
UNLABELLED Methicillin-resistant Staphylococcus aureus (MRSA) USA300 is a successful S. aureus clone in the United States and a common cause of skin and soft tissue infections (SSTIs). We performed whole-genome sequencing (WGS) of 146 USA300 MRSA isolates from SSTIs and colonization cultures obtained from an investigation conducted from 2008 to 2010 in Chicago and Los Angeles households that included an index case with an S. aureus SSTI. Identifying unique single nucleotide polymorphisms (SNPs) and analyzing whole-genome phylogeny, we characterized isolates to understand transmission dynamics, genetic relatedness, and microevolution of USA300 MRSA within the households. We also compared the 146 USA300 MRSA isolates from our study with the previously published genome sequences of the USA300 MRSA isolates from San Diego (n = 35) and New York City (n = 277). We found little genetic variation within the USA300 MRSA household isolates from Los Angeles (mean number of SNPs ± standard deviation, 17.6 ± 35; π nucleotide diversity, 3.1 × 10(-5)) or from Chicago (mean number of SNPs ± standard deviation, 12 ± 19; π nucleotide diversity, 3.1 × 10(-5)). The isolates within a household clustered into closely related monophyletic groups, suggesting the introduction into and transmission within each household of a single common USA300 ancestral strain. From a Bayesian evolutionary reconstruction, we inferred that USA300 persisted within households for 2.33 to 8.35 years prior to sampling. We also noted that fluoroquinolone-resistant USA300 clones emerged around 1995 and were more widespread in Los Angeles and New York City than in Chicago. Our findings strongly suggest that unique USA300 MRSA isolates are transmitted within households that contain an individual with an SSTI. Decolonization of household members may be a critical component of prevention programs to control USA300 MRSA spread in the United States. IMPORTANCE USA300, a virulent and easily transmissible strain of methicillin-resistant Staphylococcus aureus (MRSA), is the predominant community-associated MRSA clone in the United States. It most commonly causes skin infections but also causes necrotizing pneumonia and endocarditis. Strategies to limit the spread of MRSA in the community can only be effective if we understand the most common sources of transmission and the microevolutionary processes that provide a fitness advantage to MRSA. We performed a whole-genome sequence comparison of 146 USA300 MRSA isolates from Chicago and Los Angeles. We show that households represent a frequent site of transmission and a long-term reservoir of USA300 strains; individuals within households transmit the same USA300 strain among themselves. Our study also reveals that a large proportion of the USA300 isolates sequenced are resistant to fluoroquinolone antibiotics. The significance of this study is that if households serve as long-term reservoirs of USA300, household MRSA eradication programs may result in a uniquely effective control method.
Collapse
|
14
|
Balachandra S, Pardos de la Gandara M, Salvato S, Urban T, Parola C, Khalida C, Kost RG, Evering TH, Pastagia M, D'Orazio BM, Tomasz A, de Lencastre H, Tobin JN. Recurrent furunculosis caused by a community-acquired Staphylococcus aureus strain belonging to the USA300 clone. Microb Drug Resist 2015; 21:237-43. [PMID: 25668150 DOI: 10.1089/mdr.2014.0283] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND A 24-year-old female with recurrent skin and soft tissue infections (SSTI) was enrolled as part of a multicenter observational cohort study conducted by a practice-based research network (PBRN) on community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA). METHODS Strains were characterized by pulsed-field gel electrophoresis (PFGE), spa typing, and multilocus sequence typing. MRSA strains were analyzed for SCCmec type and the presence of the Panton-Valentine leukocidin (PVL) and arginine catabolic mobile element (ACME) using PCR. RESULTS In the first episode, S. aureus was recovered from the wound and inguinal folds; in the second, S. aureus was recovered from a lower abdomen furuncle, inguinal folds, and patellar fold. Molecular typing identified CA-MRSA clone USA300 in all samples as spa-type t008, ST8, SCCmecIVa, and a typical PFGE pattern. The strain carried virulence genes pvl and ACME type I. Five SSTI episodes were documented despite successful resolution by antibiotic treatment, with and without incision and drainage. CONCLUSIONS The source of the USA300 strain remains unknown. The isolate may represent a persistent strain capable of surviving extensive antibiotic pressure or a persistent environmental reservoir may be the source, possibly in the patient's household, from which bacteria were repeatedly introduced into the skin flora with subsequent infections.
Collapse
|
15
|
Lee GC, Long SW, Musser JM, Beres SB, Olsen RJ, Dallas SD, Nunez YO, Frei CR. Comparative Whole Genome Sequencing of Community-Associated Methicillin-Resistant Staphylococcus aureus
Sequence Type 8 from Primary Care Clinics in a Texas Community. Pharmacotherapy 2015; 35:220-8. [DOI: 10.1002/phar.1536] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Grace C. Lee
- College of Pharmacy; The University of Texas at Austin; Austin Texas
- School of Medicine; The University of Texas Health Science Center; San Antonio Texas
| | - S. Wesley Long
- Center for Molecular and Translational Infectious Diseases; Houston Methodist Research Institute; Houston Methodist Hospital; Houston Texas
- Department of Pathology and Genomic Medicine; Houston Methodist Hospital; Houston Texas
| | - James M. Musser
- Center for Molecular and Translational Infectious Diseases; Houston Methodist Research Institute; Houston Methodist Hospital; Houston Texas
- Department of Pathology and Genomic Medicine; Houston Methodist Hospital; Houston Texas
| | - Stephen B. Beres
- Center for Molecular and Translational Infectious Diseases; Houston Methodist Research Institute; Houston Methodist Hospital; Houston Texas
- Department of Pathology and Genomic Medicine; Houston Methodist Hospital; Houston Texas
| | - Randall J. Olsen
- Center for Molecular and Translational Infectious Diseases; Houston Methodist Research Institute; Houston Methodist Hospital; Houston Texas
- Department of Pathology and Genomic Medicine; Houston Methodist Hospital; Houston Texas
| | - Steven D. Dallas
- School of Medicine; The University of Texas Health Science Center; San Antonio Texas
| | - Yury O. Nunez
- College of Pharmacy; The University of Texas at Austin; Austin Texas
- School of Medicine; The University of Texas Health Science Center; San Antonio Texas
| | - Christopher R. Frei
- College of Pharmacy; The University of Texas at Austin; Austin Texas
- School of Medicine; The University of Texas Health Science Center; San Antonio Texas
| |
Collapse
|
16
|
Lozano C, Marí A, Aspiroz C, Gómez-Sanz E, Ceballos S, Fortuño B, Barcenilla F, Jover-Sáenz A, Torres C. Nasal carriage of coagulase positive staphylococci in patients of a Primary-Healthcare-Center: genetic lineages and resistance and virulence genes. Enferm Infecc Microbiol Clin 2014; 33:391-6. [PMID: 25459195 DOI: 10.1016/j.eimc.2014.09.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Revised: 07/30/2014] [Accepted: 09/11/2014] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Staphylococcus aureus and Staphylococcus pseudintermedius are highly important due to their capacity for producing diseases in humans and animals, respectively. The aim of the study was to investigate and characterize the coagulase positive Staphylococcus (CoPS) carriage in a Primary Healthcare Center population. METHODS Nasal swabs were obtained from 281 non-infectious patients. The CoPS isolates recovered were typed, and their resistance phenotype and genotype, as well as their virulence profiles, were analyzed. RESULTS CoPS isolates were recovered from 56/281 patients (19.9%). Fifty-five were S. aureus (19.6%), 54 were methicillin susceptible (MSSA) and one was methicillin resistant (MRSA). The remaining isolate was S. pseudintermedius (0.4%). A high diversity of spa-types (n=40) was detected, with 6 of them being new ones. The multi-locus-sequence-typing of 13 MSSA and one MRSA selected isolates was performed and the STs detected were: ST8, ST15, ST30, ST34, ST121, ST146, ST398, ST554, ST942, ST2499, and ST2500 (the last two STs being new). One MSSA isolate was typed as t1197-ST398-(Clonal complex)CC398. The MRSA isolate was typed as t002-ST146-CC5-SCCmec-IVc, and exhibited a multiresistance phenotype. The detected resistances were: penicillin (76%), macrolides (7%), tetracycline (7%), trimethoprim-sulfamethoxazole (7%), quinolones (7%), and lincosamides (5%). Five isolates contained lukF/lukS-PV genes, 17 tst gene, one eta gene, and two etb gene. The S. pseudintermedius isolate presented a new spa-type (t57) (belonging to a new ST180) and the genes lukS/F-I, siet, se-int, and expB. CONCLUSIONS A high genetic diversity of S. aureus was detected. Mention must be made of the identification of MSSA CC398 and S. pseudintermedius isolates in two patients, one of them with animal contact. The detection of the genes lukF/lukS-PV and tst should be noted.
Collapse
Affiliation(s)
- Carmen Lozano
- Área Bioquímica y Biología Molecular, Universidad de La Rioja, Logrono, Spain
| | - Alba Marí
- Ambulatorio Área Básica de Salud Balàfia-Pardinyes-Secà, Lérida, Spain
| | - Carmen Aspiroz
- Unidad de Microbiología, Hospital Royo Villanova, Zaragoza, Spain
| | - Elena Gómez-Sanz
- Área Bioquímica y Biología Molecular, Universidad de La Rioja, Logrono, Spain
| | - Sara Ceballos
- Área Bioquímica y Biología Molecular, Universidad de La Rioja, Logrono, Spain
| | - Blanca Fortuño
- Unidad de Microbiología, Hospital Royo Villanova, Zaragoza, Spain
| | - Fernando Barcenilla
- Unidad Funcional de Infección Nosocomial, Hospital Universitario Arnau de Vilanova, Lérida, Spain
| | - Alfredo Jover-Sáenz
- Unidad Funcional de Infección Nosocomial, Hospital Universitario Arnau de Vilanova, Lérida, Spain
| | - Carmen Torres
- Área Bioquímica y Biología Molecular, Universidad de La Rioja, Logrono, Spain.
| |
Collapse
|
17
|
Altman DR, Sebra R, Hand J, Attie O, Deikus G, Carpini KWD, Patel G, Rana M, Arvelakis A, Grewal P, Dutta J, Rose H, Shopsin B, Daefler S, Schadt E, Kasarskis A, van Bakel H, Bashir A, Huprikar S. Transmission of methicillin-resistant Staphylococcus aureus via deceased donor liver transplantation confirmed by whole genome sequencing. Am J Transplant 2014; 14:2640-4. [PMID: 25250641 PMCID: PMC4651443 DOI: 10.1111/ajt.12897] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Revised: 04/17/2014] [Accepted: 05/05/2014] [Indexed: 01/25/2023]
Abstract
Donor-derived bacterial infection is a recognized complication of solid organ transplantation (SOT). The present report describes the clinical details and successful outcome in a liver transplant recipient despite transmission of methicillin-resistant Staphylococcus aureus (MRSA) from a deceased donor with MRSA endocarditis and bacteremia. We further describe whole genome sequencing (WGS) and complete de novo assembly of the donor and recipient MRSA isolate genomes, which confirms that both isolates are genetically 100% identical. We propose that similar application of WGS techniques to future investigations of donor bacterial transmission would strengthen the definition of proven bacterial transmission in SOT, particularly in the presence of highly clonal bacteria such as MRSA. WGS will further improve our understanding of the epidemiology of bacterial transmission in SOT and the risk of adverse patient outcomes when it occurs.
Collapse
Affiliation(s)
- D. R. Altman
- Division of Infectious Diseases, Department of Medicine, Icahn School of Medicine, New York, NY
| | - R. Sebra
- Institute and Department of Genetics and Genomic Sciences, Icahn School of Medicine, New York, NY
| | - J. Hand
- Division of Infectious Diseases, Department of Medicine, Icahn School of Medicine, New York, NY
| | - O. Attie
- Institute and Department of Genetics and Genomic Sciences, Icahn School of Medicine, New York, NY
| | - G. Deikus
- Institute and Department of Genetics and Genomic Sciences, Icahn School of Medicine, New York, NY
| | | | - G. Patel
- Division of Infectious Diseases, Department of Medicine, Icahn School of Medicine, New York, NY
| | - M. Rana
- Division of Infectious Diseases, Department of Medicine, Icahn School of Medicine, New York, NY
| | - A. Arvelakis
- Recanati-Miller Transplant Institute, Icahn School of Medicine, New York, NY
| | - P. Grewal
- Recanati-Miller Transplant Institute, Icahn School of Medicine, New York, NY
| | - J. Dutta
- Institute and Department of Genetics and Genomic Sciences, Icahn School of Medicine, New York, NY
| | - H. Rose
- Division of Infectious Diseases, Department of Medicine, NYU School of Medicine, New York, NY
| | - B. Shopsin
- Division of Infectious Diseases, Department of Medicine, NYU School of Medicine, New York, NY
| | - S. Daefler
- Division of Infectious Diseases, Department of Medicine, Icahn School of Medicine, New York, NY
| | - E. Schadt
- Institute and Department of Genetics and Genomic Sciences, Icahn School of Medicine, New York, NY
| | - A. Kasarskis
- Institute and Department of Genetics and Genomic Sciences, Icahn School of Medicine, New York, NY
| | - H. van Bakel
- Institute and Department of Genetics and Genomic Sciences, Icahn School of Medicine, New York, NY
| | - A. Bashir
- Institute and Department of Genetics and Genomic Sciences, Icahn School of Medicine, New York, NY
| | - S. Huprikar
- Division of Infectious Diseases, Department of Medicine, Icahn School of Medicine, New York, NY,Corresponding author: Shirish Huprikar,
| |
Collapse
|
18
|
Absence of patient-to-patient intrahospital transmission of Staphylococcus aureus as determined by whole-genome sequencing. mBio 2014; 5:e01692-14. [PMID: 25293757 PMCID: PMC4196229 DOI: 10.1128/mbio.01692-14] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Nosocomial transmission of pathogens is a major health care challenge. The increasing spread of antibiotic-resistant strains represents an ongoing threat to public health. Previous Staphylococcus aureus transmission studies have focused on transmission of S. aureus between asymptomatic carriers or used low-resolution typing methods such as multilocus sequence typing (MLST) or spa typing. To identify patient-to-patient intrahospital transmission using high-resolution genetic analysis, we sequenced the genomes of a consecutive set of 398 S. aureus isolates from sterile-site infections. The S. aureus strains were collected from four hospitals in the Houston Methodist Hospital System over a 6-month period. Importantly, we discovered no evidence of transmission of S. aureus between patients with sterile-site infections. The lack of intrahospital transmission may reflect a fundamental difference between day-to-day transmission events in the hospital setting and the more frequently studied outbreak scenarios. Previous studies have suggested that nosocomial transmission of S. aureus is common. Our data revealed an unexpected lack of evidence for intrahospital transmission of S. aureus between patients with invasive infections. This finding has important implications for hospital infection control and public health efforts. In addition, our data demonstrate that highly related pools of S. aureus strains exist in the community which may complicate outbreak investigations.
Collapse
|
19
|
Molecular tracing of the emergence, diversification, and transmission of S. aureus sequence type 8 in a New York community. Proc Natl Acad Sci U S A 2014; 111:6738-43. [PMID: 24753569 DOI: 10.1073/pnas.1401006111] [Citation(s) in RCA: 133] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
During the last 2 decades, community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) strains have dramatically increased the global burden of S. aureus infections. The pandemic sequence type (ST)8/pulsed-field gel type USA300 is the dominant CA-MRSA clone in the United States, but its evolutionary history and basis for biological success are incompletely understood. Here, we use whole-genome sequencing of 387 ST8 isolates drawn from an epidemiological network of CA-MRSA infections and colonizations in northern Manhattan to explore short-term evolution and transmission patterns. Phylogenetic analysis predicted that USA300 diverged from a most common recent ancestor around 1993. We found evidence for multiple introductions of USA300 and reconstructed the phylogeographic spread of isolates across neighborhoods. Using pair-wise single-nucleotide polymorphism distances as a measure of genetic relatedness between isolates, we observed that most USA300 isolates had become endemic in households, indicating their critical role as reservoirs for transmission and diversification. Using the maximum single-nucleotide polymorphism variability of isolates from within households as a threshold, we identified several possible transmission networks beyond households. Our study also revealed the evolution of a fluoroquinolone-resistant subpopulation in the mid-1990s and its subsequent expansion at a time of high-frequency outpatient antibiotic use. This high-resolution phylogenetic analysis of ST8 has documented the genomic changes associated with USA300 evolution and how some of its recent evolution has been shaped by antibiotic use. By integrating whole-genome sequencing with detailed epidemiological analyses, our study provides an important framework for delineating the full diversity and spread of USA300 and other emerging pathogens in large urban community populations.
Collapse
|
20
|
Chatterjee SS, Otto M. Improved understanding of factors driving methicillin-resistant Staphylococcus aureus epidemic waves. Clin Epidemiol 2013; 5:205-17. [PMID: 23861600 PMCID: PMC3707418 DOI: 10.2147/clep.s37071] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) remains one of the most important causes of nosocomial infections worldwide. Since the global spread of MRSA in the 1960s, MRSA strains have evolved with increased pathogenic potential. Notably, some strains are now capable of causing persistent infections not only in hospitalized patients but also in healthy individuals in the community. Furthermore, MRSA is increasingly associated with infections among livestock-associated workers, primarily because of transmission from animals to humans. Moreover, many MRSA strains have gained resistance to most available antibiotics. In this review, we will present current knowledge on MRSA epidemiology and discuss new endeavors being undertaken to understand better the molecular and epidemiological underpinnings of MRSA outbreaks.
Collapse
Affiliation(s)
- Som S Chatterjee
- Pathogen Molecular Genetics Section, National Institute of Allergy and Infectious Diseases, Bethesda, MD, USA
| | | |
Collapse
|
21
|
Lindsay JA. Evolution of Staphylococcus aureus and MRSA during outbreaks. INFECTION GENETICS AND EVOLUTION 2013; 21:548-53. [PMID: 23665384 DOI: 10.1016/j.meegid.2013.04.017] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2013] [Revised: 04/10/2013] [Accepted: 04/13/2013] [Indexed: 01/24/2023]
Abstract
Investigation of Staphylococcus aureus outbreaks, and particularly those due to methicillin-resistant S. aureus (MRSA) in hospitals, can identify infection reservoirs and prevent further colonization and infection. During outbreaks, S. aureus genomes develop single nucleotide polymorphisms (SNPs), small genetic rearrangements, and/or acquire and lose mobile genetic elements (MGE) encoding resistance and virulence genes. Whole genome sequencing (WGS) is the most powerful method for discriminating between related isolates and deciding which are involved in an outbreak. Isolates with only minor variations are detectable and can identify MRSA transmission routes and identify reservoirs. Some patients may carry 'clouds' of related isolates, and this has consequences for how we interpret the data from outbreak investigations. Different clones of MRSA are evolving at different rates, influencing their typability. S. aureus genome variation reveals the importance of antibiotic resistance in the long term evolution of successful hospital clones, contributing to strategies to prevent the spread of successful MRSA clones.
Collapse
Affiliation(s)
- Jodi A Lindsay
- Infection and Immunity Research Centre, Division of Clinical Sciences, St George's University of London, Cranmer Terrace, London SW17 0RE, UK.
| |
Collapse
|
22
|
Evolution of community- and healthcare-associated methicillin-resistant Staphylococcus aureus. INFECTION GENETICS AND EVOLUTION 2013; 21:563-74. [PMID: 23648426 DOI: 10.1016/j.meegid.2013.04.030] [Citation(s) in RCA: 126] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2013] [Revised: 04/22/2013] [Accepted: 04/25/2013] [Indexed: 11/23/2022]
Abstract
Staphylococcus aureus is a prominent cause of human infections globally. The high prevalence of infections is compounded by antibiotic resistance--a significant problem for treatment. Methicillin-resistant S. aureus (MRSA) is endemic in hospitals and healthcare facilities worldwide, and is an increasingly common cause of community-associated bacterial infections in industrialized countries. Although much focus is placed on the role of S. aureus as a human pathogen, it is in fact a human commensal organism that has had a relatively long coexistence with the human host. Many S. aureus infections can be explained by host susceptibility or other predisposing risk factors. On the other hand, the emergence/re-emergence of successful S. aureus clones (referred to as epidemic waves) suggests a rapid bacterial adaption and evolution, which includes the emergence of antibiotic resistance and increased virulence and/or transmissibility. It is within this context that we review our understanding of selected S. aureus epidemic waves, and highlight the use of genome sequencing as a means to better understand the evolution of each lineage.
Collapse
|