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Gulone L, Di Gregorio S, Morales M, Haim MS, García S, Perazzi B, Famiglietti A, Mollerach M. The Changing Epidemiology and Antimicrobial Susceptibility of Staphylococcus aureus Isolated from Blood Cultures in a University Hospital from Argentina. Microb Drug Resist 2024; 30:109-117. [PMID: 38133499 DOI: 10.1089/mdr.2023.0219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023] Open
Abstract
Staphylococcus aureus bacteremia (SAB) is one of the most common serious bacterial infections worldwide. In this study, we demonstrated changes in SAB epidemiology in an Argentinean University Hospital during an 8-year period (2009-2016). A total of 326 S. aureus clinical isolates were recovered in three periods: P1: 2009-2010, P2: 2012-2014, and P3: 2015-2016. Among these, 127 were methicillin-resistant S. aureus (MRSA) and were characterized by phenotypic and molecular methods. We hereby report a significant decline in multiple drug resistance among MRSA isolates associated with an increase in SCCmec IV between the three periods. A diversity of MRSA-IV clones (mainly ST30-MRSA-IV, ST5-MRSA-IV, and ST8-MRSA-IV) replaced between 2009 and 2016 the previous prevalent MRSA clone causing bloodstream infections at this hospital (ST5-MRSA-I). MRSA population structure continued to diversify between P2 and P3. Notably, ST8-MRSA-IV-t008 related to USA300 was first detected during P2, and ST8-MRSA-IV together with ST30-MRSA-IV related to the Southwest Pacific clone were the more prevalent MRSA genotypes circulating during P3.
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Affiliation(s)
- Lucía Gulone
- Universidad de Buenos Aires, Facultad de Farmacia y Bioquímica, Instituto de Investigaciones en Bacteriología y Virología Molecular (IBaViM), Ciudad Autónoma de Buenos Aires, Argentina
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Ciudad Autónoma de Buenos Aires, Argentina
| | - Sabrina Di Gregorio
- Universidad de Buenos Aires, Facultad de Farmacia y Bioquímica, Instituto de Investigaciones en Bacteriología y Virología Molecular (IBaViM), Ciudad Autónoma de Buenos Aires, Argentina
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Ciudad Autónoma de Buenos Aires, Argentina
| | - Maia Morales
- Universidad de Buenos Aires, Facultad de Farmacia y Bioquímica, Hospital de Clínicas José de San Martín, Laboratorio de Bacteriología Clínica, Ciudad Autónoma de Buenos Aires, Argentina
| | - María Sol Haim
- Universidad de Buenos Aires, Facultad de Farmacia y Bioquímica, Instituto de Investigaciones en Bacteriología y Virología Molecular (IBaViM), Ciudad Autónoma de Buenos Aires, Argentina
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Ciudad Autónoma de Buenos Aires, Argentina
| | - Susana García
- Universidad de Buenos Aires, Facultad de Farmacia y Bioquímica, Hospital de Clínicas José de San Martín, Laboratorio de Bacteriología Clínica, Ciudad Autónoma de Buenos Aires, Argentina
| | - Beatriz Perazzi
- Universidad de Buenos Aires, Facultad de Farmacia y Bioquímica, Hospital de Clínicas José de San Martín, Laboratorio de Bacteriología Clínica, Ciudad Autónoma de Buenos Aires, Argentina
| | - Angela Famiglietti
- Universidad de Buenos Aires, Facultad de Farmacia y Bioquímica, Hospital de Clínicas José de San Martín, Laboratorio de Bacteriología Clínica, Ciudad Autónoma de Buenos Aires, Argentina
| | - Marta Mollerach
- Universidad de Buenos Aires, Facultad de Farmacia y Bioquímica, Instituto de Investigaciones en Bacteriología y Virología Molecular (IBaViM), Ciudad Autónoma de Buenos Aires, Argentina
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Ciudad Autónoma de Buenos Aires, Argentina
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2
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Barcudi D, Blasko E, Gonzalez MJ, Gagetti P, Lamberghini R, Garnero A, Sarkis C, Faccone D, Lucero C, Tosoroni D, Bocco JL, Corso A, Sola C. Different evolution of S. aureus methicillin-resistant and methicillin-susceptible infections, Argentina. Heliyon 2024; 10:e22610. [PMID: 38163174 PMCID: PMC10755277 DOI: 10.1016/j.heliyon.2023.e22610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 11/14/2023] [Accepted: 11/15/2023] [Indexed: 01/03/2024] Open
Abstract
Staphylococcus aureus-(SA) is widespread among healthcare-associated-(HA) and the community-associated-(CA) infections. However, the contributions of MRSA and MSSA to the SA overall burden remain unclear. In a nationally-representative-survey conducted in Argentina, 668 SA clinical isolates from 61 hospitals were examined in a prospective, cross-sectional, multicenter study in April 2015. The study aimed to analyze MRSA molecular epidemiology, estimate overall SA infection incidence (MSSA, MRSA, and genotypes) in community-onset (CO: HACO, Healthcare-Associated-CO and CACO, Community-Associated-CO) and healthcare-onset (HO: HAHO, Healthcare-associated-HO) infections, stratified by age groups. Additionally temporal evolution was estimated by comparing this study's (2015) incidence values with a previous study (2009) in the same region. Erythromycin-resistant-MSSA and all MRSA strains were genetically typed. The SA total-infections (TI) overall-incidence was 49.1/100,000 monthly-visits, 25.1 and 24.0 for MRSA and MSSA respectively (P = 0.5889), in April 2015. In adults with invasive-infections (INVI), MSSA was 15.7 and MRSA was 11.8 (P = 0.0288), 1.3-fold higher. HA SA infections, both MSSA and MRSA, surpassed CA infections by over threefold. During 2009-2015, there was a significant 23.4 % increase in the SA infections overall-incidence, mainly driven by MSSA, notably a 54.2 % increase in INVI among adults, while MRSA infection rates remained stable. The MSSA rise was accompanied by increased antimicrobial resistance, particularly to erythromycin, linked to MSSA-CC398-t1451-ermT + -IEC+-pvl- emergence. The SA-infections rise was primarily attributed to community-onset-infections (37.3 % and 62.4 % increase for TI and INVI, respectively), particularly HACO-MSSA and HACO-MRSA in adults, as well as CACO-MSSA. The main CA-MRSA-PFGE-typeN-ST30-SCCmecIVc-PVL+/- clone along with other clones (USA300-ST8-IV-LV-PVL+/-, PFGE-typeDD-ST97-IV- PVL-) added to rather than replaced CA-MRSA-PFGE-typeI-ST5-SCCmecIVa-PVL+/- clone in HA invasive-infections. They also displaced clone HA-MRSA-PFGE-typeA-ST5-SCCmecI, mainly in HAHO infections. The overall-burden of SA infections is rising in Argentina, driven primarily by community-onset MSSA, particularly in adults, linked to increased erythromycin-resistance and MSSA-CC398-t1451-ermT + -IEC+-pvl- emergence. Novel knowledge and transmission-control strategies are required for MSSA.
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Affiliation(s)
- Danilo Barcudi
- Centro de Investigaciones en Bioquímica Clínica e Inmunología (CIBICI) CONICET and Universidad Nacional de Córdoba, Departamento de Bioquímica Clínica, Facultad de Ciencias Químicas, Haya de La Torre y Medina Allende, Ciudad Universitaria, X5000, Córdoba, Argentina
| | - Enrique Blasko
- Centro de Investigaciones en Bioquímica Clínica e Inmunología (CIBICI) CONICET and Universidad Nacional de Córdoba, Departamento de Bioquímica Clínica, Facultad de Ciencias Químicas, Haya de La Torre y Medina Allende, Ciudad Universitaria, X5000, Córdoba, Argentina
| | - María José Gonzalez
- Centro de Investigaciones en Bioquímica Clínica e Inmunología (CIBICI) CONICET and Universidad Nacional de Córdoba, Departamento de Bioquímica Clínica, Facultad de Ciencias Químicas, Haya de La Torre y Medina Allende, Ciudad Universitaria, X5000, Córdoba, Argentina
| | - Paula Gagetti
- Servicio Antimicrobianos, Instituto Nacional de Enfermedades Infecciosas (INEI)-ANLIS “Dr. Carlos G. Malbrán”, Ciudad Autónoma de Buenos Aires, Argentina
| | - Ricardo Lamberghini
- Cátedra de Infectología I, Hospital Rawson, Facultad de Ciencias Médicas, Universidad Nacional de Córdoba, Bajada Pucará 2025, X5000, Córdoba, Argentina
| | - Analía Garnero
- Servicio de Infectología, Hospital de Niños de la Santísima Trinidad de Córdoba, Córdoba, Bajada Pucará 787, X 5000, ANN, Argentina
| | - Claudia Sarkis
- Hospital de Pediatría S.A.M.I.C."Prof. Dr. Juan P. Garrahan”, Combate de los Pozos 1881, C1245, AAM, CABA, Argentina
| | - Diego Faccone
- Servicio Antimicrobianos, Instituto Nacional de Enfermedades Infecciosas (INEI)-ANLIS “Dr. Carlos G. Malbrán”, Ciudad Autónoma de Buenos Aires, Argentina
| | - Celeste Lucero
- Servicio Antimicrobianos, Instituto Nacional de Enfermedades Infecciosas (INEI)-ANLIS “Dr. Carlos G. Malbrán”, Ciudad Autónoma de Buenos Aires, Argentina
| | - Dario Tosoroni
- Informática Médica, Facultad de Medicina, Universidad Católica de Córdoba, Jacinto Ríos 555, X5004, ASK, Córdoba, Argentina
| | | | - José L. Bocco
- Centro de Investigaciones en Bioquímica Clínica e Inmunología (CIBICI) CONICET and Universidad Nacional de Córdoba, Departamento de Bioquímica Clínica, Facultad de Ciencias Químicas, Haya de La Torre y Medina Allende, Ciudad Universitaria, X5000, Córdoba, Argentina
| | - Alejandra Corso
- Servicio Antimicrobianos, Instituto Nacional de Enfermedades Infecciosas (INEI)-ANLIS “Dr. Carlos G. Malbrán”, Ciudad Autónoma de Buenos Aires, Argentina
| | - Claudia Sola
- Centro de Investigaciones en Bioquímica Clínica e Inmunología (CIBICI) CONICET and Universidad Nacional de Córdoba, Departamento de Bioquímica Clínica, Facultad de Ciencias Químicas, Haya de La Torre y Medina Allende, Ciudad Universitaria, X5000, Córdoba, Argentina
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3
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Akbari H, Mohammadi M. The prevalence of methicillin-resistant Staphylococcus aureus in the noses of Iranian medical staff: a systematic review and meta-analysis. J Public Health (Oxf) 2022. [DOI: 10.1007/s10389-022-01759-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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4
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Montes O, Hernández J, Correa O, Reyes J, Pinzon H, Reyes N. Clonal Distribution and Antibiotic Susceptibility of Staphylococcus aureus from Pediatric Patients: 8-Year Trends in a Children's Hospital in Colombia. J Trop Pediatr 2021; 67:6471245. [PMID: 34931252 DOI: 10.1093/tropej/fmab105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Emergence of community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) strains in healthcare settings has changed the hospital epidemiology of MRSA in the last few years. Despite a global increase in MRSA frequency, infections caused by methicillin-susceptible S. aureus (MSSA) have persisted in healthcare settings and the community. Staphylococcus aureus isolates were collected between 2009 and 2017 at the Children's Hospital of a Caribbean city in South America. Methicillin-resistant isolates were subjected to SCCmec typing. Representative isolates were analyzed by multilocus sequence typing (MLST) and spa typing. Antibiotic susceptibility was assessed by agar dilution method. D-zone test was performed in erythromycin-resistant isolates to determine macrolide/lincosamide/streptogramin resistance. Spa typing revealed 10 different spa types. The main epidemic clones circulating during the study period were: ST8-MRSA-IVc, ST923-MRSA-IVa and ST8-MRSA-IVa. The study found high frequencies of PVL genes and resistance to erythromycin and clindamycin in the isolates. This study provides the first description of the population structure of MRSA and MSSA causing infections attended in the participating Children's Hospital. ST8-MRSA-IVc, ST923-MRSA-IVa and ST8-MRSA-IVa were the most prevalent in the isolate population.
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Affiliation(s)
- Oscar Montes
- Research Group of Genetics and Molecular Biology, University of Cartagena, Cartagena, Bolivar 130001, Colombia
| | - Jordan Hernández
- Research Group of Genetics and Molecular Biology, University of Cartagena, Cartagena, Bolivar 130001, Colombia
| | - Oscar Correa
- Research Group of Genetics and Molecular Biology, University of Cartagena, Cartagena, Bolivar 130001, Colombia
| | - Jeison Reyes
- Research Group of Genetics and Molecular Biology, University of Cartagena, Cartagena, Bolivar 130001, Colombia.,Escuela de Cuidado de la Salud, Universidad de los Llanos, Villavicencio, Meta 500003, Colombia
| | - Hernando Pinzon
- Research Group of Genetics and Molecular Biology, University of Cartagena, Cartagena, Bolivar 130001, Colombia
| | - Niradiz Reyes
- Research Group of Genetics and Molecular Biology, Department of Basic Sciences, School of Medicine, University of Cartagena, Cartagena, Bolivar 130001, Colombia
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5
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Khan A, Rivas LM, Spencer M, Martinez R, Lam M, Rojas P, Porte L, Silva F, Braun S, Valdivieso F, Mv Lhauser M, Lafourcade M, Miller WR, García P, Arias CA, Munita JM. A Multicenter Study To Evaluate Ceftaroline Breakpoints: Performance in an Area with High Prevalence of Methicillin-Resistant Staphylococcus aureus Sequence Type 5 Lineage. J Clin Microbiol 2019; 57:e00798-19. [PMID: 31315958 PMCID: PMC6711923 DOI: 10.1128/jcm.00798-19] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 07/04/2019] [Indexed: 12/12/2022] Open
Abstract
Ceftaroline (CPT) is a broad-spectrum agent with potent activity against methicillin-resistant Staphylococcus aureus (MRSA). The sequence type 5 (ST5) Chilean-Cordobés clone, associated with CPT nonsusceptibility, is dominant in Chile, a region with high rates of MRSA infections. Here, we assessed the in vitro activity of CPT against a collection of MRSA isolates collected between 1999 and 2018 from nine hospitals (n = 320) and community settings (n = 41) in Santiago, Chile, and evaluated performance across testing methodologies. We found that our hospital-associated isolates exhibited higher CPT MIC distributions (MIC50 and MIC90 of 2 mg/liter) than the community isolates (MIC50 and MIC90 of 0.5 mg/liter), a finding that was consistent across time and independent of the culture source. High proportions (64%) of isolates were CPT nonsusceptible despite the absence of CPT use in Chile. Across methodologies, the Etest underestimated the MIC relative to the gold standard broth microdilution (BMD) test (MIC50 and MIC90 of 1 and 1.5 mg/liter, respectively). There was low (∼51%) categorical agreement (CA) between Etest and BMD results across CLSI and EUCAST breakpoints. The recent revision of CLSI guidelines abolished "very major error" (VME) from the previous guidelines (81%), which perform similarly to the EUCAST guidelines. The level of concordance between CLSI and EUCAST for BMD testing and Etest was >95%. Disk diffusion performed poorly relative to BMD under CLSI (CA, 55%) and EUCAST (CA, 36%) guidelines. Comparison of EUCAST to CLSI for disk diffusion (with EUCAST used as the reference) showed low agreement (CA, 25%; VME, 70%). In summary, CPT-nonsusceptible MRSA are dominant in clinical settings in Chile. Our results provide data to support the reevaluation of CPT breakpoints and to improve agreement across methodologies and agencies.
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Affiliation(s)
- Ayesha Khan
- Center for Antimicrobial Resistance and Microbial Genomics and Division of Infectious Diseases, University of Texas Health Science Center, McGovern Medical School, Houston, Texas, USA
- Department of Microbiology and Molecular Genetics, University of Texas Health Science Center, McGovern Medical School, Houston, Texas, USA
- MD Anderson Cancer Center, UT Health Graduate School of Biomedical Sciences, Houston, Texas, USA
| | - Lina M Rivas
- Genomics and Resistant Microbes Group, Facultad de Medicina-Clinica Alemana, Universidad del Desarrollo, Santiago, Chile
- Millennium Initiative for Collaborative Research on Bacterial Resistance (MICROB-R), Millennium Science Initiative, Santiago, Chile
| | - Maria Spencer
- Genomics and Resistant Microbes Group, Facultad de Medicina-Clinica Alemana, Universidad del Desarrollo, Santiago, Chile
- Millennium Initiative for Collaborative Research on Bacterial Resistance (MICROB-R), Millennium Science Initiative, Santiago, Chile
| | - Rodrigo Martinez
- Genomics and Resistant Microbes Group, Facultad de Medicina-Clinica Alemana, Universidad del Desarrollo, Santiago, Chile
- Millennium Initiative for Collaborative Research on Bacterial Resistance (MICROB-R), Millennium Science Initiative, Santiago, Chile
| | - Marusella Lam
- Departamento de Laboratorios Clínicos, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | | | - Lorena Porte
- Genomics and Resistant Microbes Group, Facultad de Medicina-Clinica Alemana, Universidad del Desarrollo, Santiago, Chile
- Millennium Initiative for Collaborative Research on Bacterial Resistance (MICROB-R), Millennium Science Initiative, Santiago, Chile
| | | | | | | | | | | | - William R Miller
- Center for Antimicrobial Resistance and Microbial Genomics and Division of Infectious Diseases, University of Texas Health Science Center, McGovern Medical School, Houston, Texas, USA
| | - Patricia García
- Millennium Initiative for Collaborative Research on Bacterial Resistance (MICROB-R), Millennium Science Initiative, Santiago, Chile
- Departamento de Laboratorios Clínicos, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Cesar A Arias
- Center for Antimicrobial Resistance and Microbial Genomics and Division of Infectious Diseases, University of Texas Health Science Center, McGovern Medical School, Houston, Texas, USA
- Department of Microbiology and Molecular Genetics, University of Texas Health Science Center, McGovern Medical School, Houston, Texas, USA
- Millennium Initiative for Collaborative Research on Bacterial Resistance (MICROB-R), Millennium Science Initiative, Santiago, Chile
- Molecular Genetics and Antimicrobial Resistance Unit, International Center for Microbial Genomics, Universidad El Bosque, Bogotá, Colombia
- Center for Infectious Diseases, University of Texas Health Science Center, School of Public Health, Houston, Texas, USA
| | - Jose M Munita
- Center for Antimicrobial Resistance and Microbial Genomics and Division of Infectious Diseases, University of Texas Health Science Center, McGovern Medical School, Houston, Texas, USA
- Genomics and Resistant Microbes Group, Facultad de Medicina-Clinica Alemana, Universidad del Desarrollo, Santiago, Chile
- Millennium Initiative for Collaborative Research on Bacterial Resistance (MICROB-R), Millennium Science Initiative, Santiago, Chile
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Lakhundi S, Zhang K. Methicillin-Resistant Staphylococcus aureus: Molecular Characterization, Evolution, and Epidemiology. Clin Microbiol Rev 2018; 31:e00020-18. [PMID: 30209034 PMCID: PMC6148192 DOI: 10.1128/cmr.00020-18] [Citation(s) in RCA: 740] [Impact Index Per Article: 123.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Staphylococcus aureus, a major human pathogen, has a collection of virulence factors and the ability to acquire resistance to most antibiotics. This ability is further augmented by constant emergence of new clones, making S. aureus a "superbug." Clinical use of methicillin has led to the appearance of methicillin-resistant S. aureus (MRSA). The past few decades have witnessed the existence of new MRSA clones. Unlike traditional MRSA residing in hospitals, the new clones can invade community settings and infect people without predisposing risk factors. This evolution continues with the buildup of the MRSA reservoir in companion and food animals. This review focuses on imparting a better understanding of MRSA evolution and its molecular characterization and epidemiology. We first describe the origin of MRSA, with emphasis on the diverse nature of staphylococcal cassette chromosome mec (SCCmec). mecA and its new homologues (mecB, mecC, and mecD), SCCmec types (13 SCCmec types have been discovered to date), and their classification criteria are discussed. The review then describes various typing methods applied to study the molecular epidemiology and evolutionary nature of MRSA. Starting with the historical methods and continuing to the advanced whole-genome approaches, typing of collections of MRSA has shed light on the origin, spread, and evolutionary pathways of MRSA clones.
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Affiliation(s)
- Sahreena Lakhundi
- Centre for Antimicrobial Resistance, Alberta Health Services/Calgary Laboratory Services/University of Calgary, Calgary, Alberta, Canada
| | - Kunyan Zhang
- Centre for Antimicrobial Resistance, Alberta Health Services/Calgary Laboratory Services/University of Calgary, Calgary, Alberta, Canada
- Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Microbiology, Immunology and Infectious Diseases, University of Calgary, Calgary, Alberta, Canada
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
- The Calvin, Phoebe and Joan Snyder Institute for Chronic Diseases, University of Calgary, Calgary, Alberta, Canada
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7
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Challagundla L, Reyes J, Rafiqullah I, Sordelli DO, Echaniz-Aviles G, Velazquez-Meza ME, Castillo-Ramírez S, Fittipaldi N, Feldgarden M, Chapman SB, Calderwood MS, Carvajal LP, Rincon S, Hanson B, Planet PJ, Arias CA, Diaz L, Robinson DA. Phylogenomic Classification and the Evolution of Clonal Complex 5 Methicillin-Resistant Staphylococcus aureus in the Western Hemisphere. Front Microbiol 2018; 9:1901. [PMID: 30186248 PMCID: PMC6113392 DOI: 10.3389/fmicb.2018.01901] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 07/27/2018] [Indexed: 12/30/2022] Open
Abstract
Clonal complex 5 methicillin-resistant Staphylococcus aureus (CC5-MRSA) includes multiple prevalent clones that cause hospital-associated infections in the Western Hemisphere. Here, we present a phylogenomic study of these MRSA to reveal their phylogeny, spatial and temporal population structure, and the evolution of selected traits. We studied 598 genome sequences, including 409 newly generated sequences, from 11 countries in Central, North, and South America, and references from Asia and Europe. An early-branching CC5-Basal clade is well-dispersed geographically, is methicillin-susceptible and MRSA predominantly of ST5-IV such as the USA800 clone, and includes separate subclades for avian and porcine strains. In the early 1970s and early 1960s, respectively, two clades appeared that subsequently underwent major expansions in the Western Hemisphere: a CC5-I clade in South America and a CC5-II clade largely in Central and North America. The CC5-I clade includes the ST5-I Chilean/Cordobes clone, and the ST228-I South German clone as an early offshoot, but is distinct from other ST5-I clones from Europe that nest within CC5-Basal. The CC5-II clade includes divergent strains of the ST5-II USA100 clone, various other clones, and most known vancomycin-resistant strains of S. aureus, but is distinct from ST5-II strain N315 from Japan that nests within CC5-Basal. The recombination rate of CC5 was much lower than has been reported for other S. aureus genetic backgrounds, which indicates that recurrence of vancomycin resistance in CC5 is not likely due to an enhanced promiscuity. An increased number of antibiotic resistances and decreased number of toxins with distance from the CC5 tree root were observed. Of note, the expansions of the CC5-I and CC5-II clades in the Western Hemisphere were preceded by convergent gains of resistance to fluoroquinolone, macrolide, and lincosamide antibiotics, and convergent losses of the staphylococcal enterotoxin p (sep) gene from the immune evasion gene cluster of phage ϕSa3. Unique losses of surface proteins were also noted for these two clades. In summary, our study has determined the relationships of different clades and clones of CC5 and has revealed genomic changes for increased antibiotic resistance and decreased virulence associated with the expansions of these MRSA in the Western Hemisphere.
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Affiliation(s)
- Lavanya Challagundla
- Department of Data Science, University of Mississippi Medical Center, Jackson, MS, United States
| | - Jinnethe Reyes
- Molecular Genetics and Antimicrobial Resistance Unit, International Center for Microbial Genomics, Universidad El Bosque, Bogota, Colombia
| | - Iftekhar Rafiqullah
- Department of Microbiology and Immunology, University of Mississippi Medical Center, Jackson, MS, United States
| | - Daniel O. Sordelli
- Instituto de Investigaciones en Microbiología y Parasitología Médica, Universidad de Buenos Aires and Consejo Nacional de Investigaciones Ciencias y Tecnicas, Buenos Aires, Argentina
| | | | | | - Santiago Castillo-Ramírez
- Programa de Genómica Evolutiva, Centro de Ciencias Génomicas, Universidad Nacional Autónoma de México, Cuernavaca, Mexico
| | - Nahuel Fittipaldi
- Public Health Ontario Laboratory, Toronto, ON, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
- Department of Cell and Systems Biology, University of Toronto, Toronto, ON, Canada
| | - Michael Feldgarden
- National Center for Biotechnology Information, National Institutes of Health, Bethesda, MD, United States
| | | | - Michael S. Calderwood
- Section of Infectious Disease and International Health, Dartmouth–Hitchcock Medical Center, Lebanon, NH, United States
| | - Lina P. Carvajal
- Molecular Genetics and Antimicrobial Resistance Unit, International Center for Microbial Genomics, Universidad El Bosque, Bogota, Colombia
| | - Sandra Rincon
- Molecular Genetics and Antimicrobial Resistance Unit, International Center for Microbial Genomics, Universidad El Bosque, Bogota, Colombia
| | - Blake Hanson
- Division of Infectious Diseases and Center for Antimicrobial Resistance and Microbial Genomics, University of Texas Health Science Center, McGovern Medical School, Houston, TX, United States
- Center for Infectious Diseases, School of Public Health, University of Texas Health Science Center, Houston, TX, United States
| | - Paul J. Planet
- Children’s Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, United States
| | - Cesar A. Arias
- Molecular Genetics and Antimicrobial Resistance Unit, International Center for Microbial Genomics, Universidad El Bosque, Bogota, Colombia
- Division of Infectious Diseases and Center for Antimicrobial Resistance and Microbial Genomics, University of Texas Health Science Center, McGovern Medical School, Houston, TX, United States
- Center for Infectious Diseases, School of Public Health, University of Texas Health Science Center, Houston, TX, United States
| | - Lorena Diaz
- Molecular Genetics and Antimicrobial Resistance Unit, International Center for Microbial Genomics, Universidad El Bosque, Bogota, Colombia
| | - D. Ashley Robinson
- Department of Microbiology and Immunology, University of Mississippi Medical Center, Jackson, MS, United States
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8
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Pena Amaya P, Haim MS, Fernández S, Di Gregorio S, Teper A, Vázquez M, Lubovich S, Galanternik L, Mollerach M. Molecular Epidemiology of Methicillin-Resistant Staphylococcus aureus in Cystic Fibrosis Patients from Argentina. Microb Drug Resist 2018; 24:613-620. [DOI: 10.1089/mdr.2017.0162] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Affiliation(s)
- Paula Pena Amaya
- Hospital de Niños “Dr. Ricardo Gutiérrez,” Buenos Aires, Argentina
| | - Maria S. Haim
- Universidad de Buenos Aires, Facultad de Farmacia y Bioquímica, Cátedra de Microbiología, Buenos Aires, Argentina
- CONICET, Buenos Aires, Argentina
| | - Silvina Fernández
- Universidad de Buenos Aires, Facultad de Farmacia y Bioquímica, Cátedra de Microbiología, Buenos Aires, Argentina
| | - Sabrina Di Gregorio
- Universidad de Buenos Aires, Facultad de Farmacia y Bioquímica, Cátedra de Microbiología, Buenos Aires, Argentina
- CONICET, Buenos Aires, Argentina
| | - Alejandro Teper
- Hospital de Niños “Dr. Ricardo Gutiérrez,” Buenos Aires, Argentina
| | - Miryam Vázquez
- Hospital de Niños “Dr. Ricardo Gutiérrez,” Buenos Aires, Argentina
| | - Silvina Lubovich
- Hospital de Niños “Dr. Ricardo Gutiérrez,” Buenos Aires, Argentina
| | | | - Marta Mollerach
- Universidad de Buenos Aires, Facultad de Farmacia y Bioquímica, Cátedra de Microbiología, Buenos Aires, Argentina
- CONICET, Buenos Aires, Argentina
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High Diversity of Methicillin-Resistant Staphylococcus aureus (MRSA) Isolates Based on Hypervariable Region Polymorphisms. ARCHIVES OF PEDIATRIC INFECTIOUS DISEASES 2016. [DOI: 10.5812/pedinfect.36433] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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10
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Mendes RE, Deshpande LM, Costello AJ, Farrell DJ, Jones RN, Flamm RK. Genotypic Characterization of Methicillin-Resistant Staphylococcus aureus Recovered at Baseline from Phase 3 Pneumonia Clinical Trials for Ceftobiprole. Microb Drug Resist 2015; 22:53-8. [PMID: 26230870 PMCID: PMC4722542 DOI: 10.1089/mdr.2014.0307] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Baseline methicillin-resistant Staphylococcus aureus (MRSA) isolates from patients with nosocomial and community-acquired pneumonia collected during Phase 3 trials for ceftobiprole were characterized. Eighty-four unique isolates from patients enrolled in Europe (50.0%), Asia-Western Pacific region (APAC; 20.2%), North America (19.0%), Latin America (8.3%), and South Africa (2.4%) were included. Antimicrobial susceptibility testing was performed by broth microdilution and isolates screened for Panton-Valentine leukocidin. SCCmec and agr types were determined. Strains were subjected to pulsed-field gel electrophoresis and spa typing. Clonal complexes (CCs) were assigned based on spa and/or multilocus sequence typing. Most isolates were CC5-MRSA-I/II/IV (44.0%; 37/84), followed by CC8-MRSA-IV (22.6%; 19/84) and CC239-MRSA-III (21.4%; 18/84). Other MRSA formed seven clonal clusters. Isolates from North America were associated with USA100, while those from South America belonged to the Cordobes/Chilean CC. A greater clonal diversity was observed in Europe; however, each country had CC5, CC8, or CC239 as prevalent lineages. Isolates from APAC were CC5-MRSA-II (47.1%; 8/17) or CC239-MRSA-III (47.1%; 8/17). Isolates carrying SCCmec I and III had ceftobiprole MIC50 values of 2 μg/ml, while those isolates with SCCmec II and IV had MIC50 values of 1 μg/ml. Ceftobiprole inhibited 96% and 100.0% of the isolates at ≤2 and ≤4 μg/ml, respectively. These isolates represented common circulating MRSA clones. Ceftobiprole demonstrated in vitro activity with a slight variation of minimum inhibitory concentrations (MICs) according to SCCmec or clonal type.
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Di Gregorio S, Perazzi B, Ordoñez AM, De Gregorio S, Foccoli M, Lasala MB, García S, Vay C, Famiglietti A, Mollerach M. Clinical, microbiological, and genetic characteristics of heteroresistant vancomycin-intermediate Staphylococcus aureus bacteremia in a teaching hospital. Microb Drug Resist 2014; 21:25-34. [PMID: 25535825 PMCID: PMC4367492 DOI: 10.1089/mdr.2014.0190] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
The emergence of vancomycin intermediate Staphylococcus aureus (VISA) and heterogeneous VISA (hVISA) is of major concern worldwide. Our objective was to investigate the prevalence, phenotypic and molecular features of hVISA strains isolated from bacteremic patients and to determine the clinical significance of the hVISA phenotype in patients with bacteremia. A total of 104 S. aureus blood isolates were collected from a teaching hospital of Argentina between August 2009 and November 2010. No VISA isolate was recovered, and 3 out of 92 patients (3.3%) were infected with hVISA, 2 of them methicillin-resistant S. aureus (MRSA) (4.5% of MRSA). Macro Etest and prediffusion method detected 3/3 and 2/3 hVISA respectively. Considering the type of bacteremia, the three cases were distributed as follows: two patients had suffered multiple episodes of bacteremia (both hVISA strains recovered in the second episode), while only one patient had suffered a single episode of bacteremia with hVISA infection. MRSA bloodstream isolates exhibiting the hVISA phenotype were related to HA-MRSA Cordobes clone (ST5-SCCmec I-spa t149) and MRSA Argentinean pediatric clone (ST100-SCCmec IVNV-spa t002), but not to CA-MRSA-ST30-SCCmec IV-spa t019 clone that was one of the most frequent in our country. Although still relatively infrequent in our hospital, hVISA strains were significantly associated with multiple episodes of bacteremia (p=0.037) and genetically unrelated.
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Affiliation(s)
- Sabrina Di Gregorio
- 1 Facultad de Farmacia y Bioquímica, Universidad de Buenos Aires , Ciudad Autónoma de Buenos Aires, Argentina
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Abstract
Staphylococcus aureus is an important pathogen linked to serious infections both in the hospital and the community settings. The challenge to treat infections caused by S. aureus has increased because of the emergence of multidrug-resistant strains such as methicillin-resistant S. aureus (MRSA). A limited spectrum of antibiotics is available to treat MRSA infections. This chapter reviews antimicrobial agents currently in use for the treatment of MRSA infections as well as agents that are in various stages of development. This chapter also reviews the alternate approaches that are being explored for the treatment of staphylococcal infections.
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Affiliation(s)
- Anu Daniel
- Cubist Pharmaceuticals, Lexington, MA, USA
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Machuca MA, Sosa LM, González CI. Molecular typing and virulence characteristic of methicillin-resistant Staphylococcus aureus isolates from pediatric patients in Bucaramanga, Colombia. PLoS One 2013; 8:e73434. [PMID: 24058415 PMCID: PMC3751954 DOI: 10.1371/journal.pone.0073434] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2012] [Accepted: 07/28/2013] [Indexed: 11/30/2022] Open
Abstract
Background Staphylococcus aureus is among the most common global nosocomial pathogens. The emergence and spread of methicillin-resistant Staphylococcus aureus (MRSA) is a public health problem worldwide that causes nosocomial and community infections. The goals of this study were to establish the clonal complexes (CC) of the isolates of MRSA obtained from pediatric patients in a university hospital in Colombia and to investigate its molecular characteristics based on the virulence genes and the genes of staphylococcal toxins and adhesins. Methods A total of 53 MRSA isolates from pediatric patients with local or systemic infections were collected. The MRSA isolates were typed based on the SCCmec, MLST, spa and agr genes. The molecular characterization included the detection of Panton-Valentine Leukocidin, superantigenic and exfoliative toxins, and adhesin genes. The correlation between the molecular types identified and the profile of virulence factors was determined for all isolates. Results Four CC were identified, including CC8, CC5, CC80 and CC78. The ST8-MRSA-IVc-agrI was the predominant clone among the isolates, followed by the ST5-MRSA-I-agrII and ST5-MRSA-IVc-agrII clones. Twelve spa types were identified, of which t10796 and t10799 were new repeat sequences. The isolates were carriers of toxin genes, and hlg (100%), sek (92%) and pvl (88%) were the most frequent. Ten toxin gene profiles were observed, and the most frequent were seq-sek-hlg (22.6%), sek-hlg (22.6%), seb-seq-sek-hlg (18.9%) and seb-sek-hlg (15.1%). The adhesion genes were present in most of the MRSA isolates, including the following: clf-A (89%), clf-B (87%), fnb-A (83%) and ica (83%). The majority of the strains carried SCCmec-IVc and were identified as causing nosocomial infection. No significant association between a molecular type and the virulence factors was found. Conclusion Four major MRSA clone complexes were identified among the isolates. ST8-MRSA-IVc-agrI pvl+ (USA300-LV) was the most frequent, confirming the presence of community-associated MRSA in Colombian hospitals.
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Affiliation(s)
- Mayra Alejandra Machuca
- Grupo de Inmunología y Epidemiología Molecular, GIEM, Facultad de Salud, Universidad Industrial de Santander, Bucaramanga, Colombia
| | - Luis Miguel Sosa
- Grupo PAIDOS, Departamento de Pediatría, Hospital Universitario de Santander, Facultad de Salud, Universidad Industrial de Santander, Bucaramanga, Colombia
| | - Clara Isabel González
- Grupo de Inmunología y Epidemiología Molecular, GIEM, Facultad de Salud, Universidad Industrial de Santander, Bucaramanga, Colombia
- * E-mail:
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Molecular epidemiology of hospital-onset methicillin-resistant Staphylococcus aureus infections in Southern Chile. Eur J Clin Microbiol Infect Dis 2013; 32:1533-40. [PMID: 23765159 DOI: 10.1007/s10096-013-1907-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2013] [Accepted: 05/29/2013] [Indexed: 10/26/2022]
Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) is a pathogen of public health importance. In Chile, the Cordobes/Chilean clone was the predominant healthcare-associated MRSA (HA-MRSA) clone in 1998. Since then, the molecular epidemiological surveillance of MRSA has not been performed in Southern Chile. We aimed to investigate the molecular epidemiology of HA-MRSA infections in Southern Chile to identify the MRSA clones involved, and their evolutionary relationships with epidemic international MRSA lineages. A total of 303 single inpatient isolates of S. aureus were collected in the Valdivia County Hospital (2007-2008), revealing 33% (100 MRSA/303) prevalence for HA-MRSA infections. The SCCmec types I and IV were identified in 97% and 3% of HA-MRSA, respectively. All isolates lacked the pvl genes. A random sample (n = 29) of all MRSA was studied by pulsed-field gel electrophoresis (PFGE), multilocus sequence typing (MLST), SCCmec subtyping, agr and spa typing, and virulence genes profiling. PFGE analysis revealed the predominance (89%, 26/29) of pulsotype A and three additional pulsotypes, designated H1, I33, and G1. Pulsotype A (ST5-SCCmecI-spa-t149) is clonally related to the Cordobes/Chilean clone. Pulsotype H1 (ST5-SCCmecIVNT-spa-t002) is genetically related to the Pediatric clone (ST5-SCCmecIV). Pulsotype I33 (ST5-SCCmecIVc-spa-t002) is clonally related by PFGE to the community-associated MRSA (CA-MRSA) clone spread in Argentina, I-ST5-IVa-PVL(+). The G1 pulsotype (ST8-SCCmecIVc-spa-t024) is clonally related to the epidemic USA300 CA-MRSA. Here, we demonstrate the stability of the Cordobes/Chilean clone over time as the major HA-MRSA clone in Southern Chile. The identification of two CA-MRSA clones might suggest that these clones have entered into the healthcare setting from the community. These results emphasize the importance of the local surveillance of MRSA infections in the community and hospital settings.
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Antimicrobial resistance and molecular typing of Staphylococcus aureus bloodstream isolates from hospitals in Peru. J Infect 2012; 65:406-11. [DOI: 10.1016/j.jinf.2012.06.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2011] [Revised: 03/03/2012] [Accepted: 06/07/2012] [Indexed: 11/20/2022]
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Saraiva AM, Saraiva CL, Gonçalves AM, Soares RR, Mendes FDO, Cordeiro RP, Xavier HS, Pisciottano MNC. Antimicrobial activity and bioautographic study of antistaphylococcal components from Caesalpinia pyramidalis Tull. BRAZ J PHARM SCI 2012. [DOI: 10.1590/s1984-82502012000100016] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The antimicrobial activity of dry methanol and ethyl acetate extracts for the leaves, bark of the stem, peel of the root, flower, fruit and seed of Caesalpinia pyramidalis Tull. (catingueira) was performed against seventeen isolates of Staphylococcus aureus MRSA multiresistant strains, which included two isolates of S. aureus MSSA and two ATCC strains. The antimicrobial activity was tested by the agar diffusion method and the Minimum Inhibitory Concentration (MIC) was determined. The dry methanol extract of the root showed good antimicrobial activity with a MIC of less than 0.5 mg.mL-1. The dry ethyl acetate extracts exhibited lower antimicrobial activity, which might be explained by solubility problems and less diffusion in the agar medium. Results of the bioautographies also confirmed inhibition halos corresponding to the active substances present in the leaves, as well as in the flower of C. pyramidalis. The phytochemical study of the leaves, bark of the stem, peel of the root, flower and fruit of extracts from C. pyramidalis confirmed the presence of a number of known antimicrobial agents including ursolic acid, quercetin, catechin, ellagic acid, sitosterol, flavonoids, proanthocyanidins and gallic acid.
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Sola C, Paganini H, Egea AL, Moyano AJ, Garnero A, Kevric I, Culasso C, Vindel A, Lopardo H, Bocco JL. Spread of epidemic MRSA-ST5-IV clone encoding PVL as a major cause of community onset staphylococcal infections in Argentinean children. PLoS One 2012; 7:e30487. [PMID: 22291965 PMCID: PMC3264586 DOI: 10.1371/journal.pone.0030487] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2011] [Accepted: 12/19/2011] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Community-associated methicillin-resistant Staphylococcus aureus-(CA-MRSA) strains have emerged in Argentina. We investigated the clinical and molecular evolution of community-onset MRSA infections (CO-MRSA) in children of Córdoba, Argentina, 2005-2008. Additionally, data from 2007 were compared with the epidemiology of these infections in other regions of the country. METHODOLOGY/PRINCIPAL FINDINGS Two datasets were used: i) lab-based prospective surveillance of CA-MRSA isolates from 3 Córdoba pediatric hospitals-(CBAH1-H3) in 2007-2008 (compared to previously published data of 2005) and ii) a sampling of CO-MRSA from a study involving both, healthcare-associated community-onset-(HACO) infections in children with risk-factors for healthcare-associated infections-(HRFs), and CA-MRSA infections in patients without HRFs detected in multiple centers of Argentina in 2007. Molecular typing was performed on the CA-MRSA-(n: 99) isolates from the CBAH1-H3-dataset and on the HACO-MRSA-(n: 51) and CA-MRSA-(n: 213) isolates from other regions. Between 2005-2008, the annual proportion of CA-MRSA/CA-S. aureus in Córdoba hospitals increased from 25% to 49%, P<0.01. Total CA-MRSA infections increased 3.6 fold-(5.1 to 18.6 cases/100,000 annual-visits, P<0.0001), associated with an important increase of invasive CA-MRSA infections-(8.5 fold). In all regions analyzed, a single genotype prevailed in both CA-MRSA (82%) and HACO-MRSA(57%), which showed pulsed-field-gel electrophoresis-(PFGE)-type-"I", sequence-type-5-(ST5), SCCmec-type-IVa, spa-t311, and was positive for PVL. The second clone, pulsotype-N/ST30/CC30/SCCmecIVc/t019/PVL(+), accounted for 11.5% of total CA-MRSA infections. Importantly, the first 4 isolates of Argentina belonging to South American-USA300 clone-(USA300/ST8/CC8/SCCmecIVc/t008/PVL(+)/ACME(-)) were detected. We also demonstrated that a HA-MRSA clone-(pulsotype-C/ST100/CC5) caused 2% and 10% of CA-MRSA and HACO-MRSA infections respectively and was associated with a SCCmec type closely related to SCCmecIV(2B&5). CONCLUSIONS/SIGNIFICANCE The dissemination of epidemic MRSA clone, ST5-IV-PVL(+) was the main cause of increasing staphylococcal community-onset infections in Argentinean children (2003-2008), conversely to other countries. The predominance of this clone, which has capacity to express the h-VISA phenotype, in healthcare-associated community-onset cases suggests that it has infiltrated into hospital-settings.
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Affiliation(s)
- Claudia Sola
- Centro de Investigaciones en Bioquímica Clínica e Inmunología (CIBICI-CONICET), Departamento de Bioquímica Clínica; Facultad de Ciencias Químicas, Universidad Nacional de Córdoba, Córdoba, Argentina
| | - Hugo Paganini
- Hospital de Pediatría “Prof. Dr.Juan P. Garrahan”, Autonomous city of Buenos Aires (ACBA), Argentina
| | - Ana L. Egea
- Centro de Investigaciones en Bioquímica Clínica e Inmunología (CIBICI-CONICET), Departamento de Bioquímica Clínica; Facultad de Ciencias Químicas, Universidad Nacional de Córdoba, Córdoba, Argentina
| | - Alejandro J. Moyano
- Centro de Investigaciones en Bioquímica Clínica e Inmunología (CIBICI-CONICET), Departamento de Bioquímica Clínica; Facultad de Ciencias Químicas, Universidad Nacional de Córdoba, Córdoba, Argentina
| | - Analia Garnero
- Hospital de Niños de la Santísima Trinidad de Córdoba, Córdoba, Argentina
| | - Ines Kevric
- Centro de Investigaciones en Bioquímica Clínica e Inmunología (CIBICI-CONICET), Departamento de Bioquímica Clínica; Facultad de Ciencias Químicas, Universidad Nacional de Córdoba, Córdoba, Argentina
| | - Catalina Culasso
- Hospital de Niños de la Santísima Trinidad de Córdoba, Córdoba, Argentina
| | - Ana Vindel
- Laboratorio de Infecciones Nosocomiales, Instituto de Salud Carlos III, Centro Nacional de Microbiología, Majadahonda, Madrid, Spain
| | | | - Horacio Lopardo
- Hospital de Pediatría “Prof. Dr.Juan P. Garrahan”, Autonomous city of Buenos Aires (ACBA), Argentina
| | - José L. Bocco
- Centro de Investigaciones en Bioquímica Clínica e Inmunología (CIBICI-CONICET), Departamento de Bioquímica Clínica; Facultad de Ciencias Químicas, Universidad Nacional de Córdoba, Córdoba, Argentina
- * E-mail:
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Paszko K, Michnowska E, Kurlenda J, Grinholc M, Nakonieczna J, Bielawski KP. MRSA distribution and epidemiological procedures evaluation at two hospitals in Northern Poland. GMS KRANKENHAUSHYGIENE INTERDISZIPLINAR 2011; 6:Doc19. [PMID: 22242100 PMCID: PMC3252643 DOI: 10.3205/dgkh000176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
In the present study we have analyzed the impact of modified MRSA screening of carriers and patients on epidemiological situation of MRSA during 2008-2010, comparing two regional hospitals with similar bed numbers and similar ward profiles in Northern Poland. In 2008 the proportion of MRSA to all S. aureus isolates was 14.4% resp. 6.0%, in 2009 8.3% resp. 4.7% and in 2010 6.5% in both hospitals. Independent of the different prevention and intervention strategy in both hospitals the different MRSA incidence seems to be due to regional epidemic settings.
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Affiliation(s)
- Krystyna Paszko
- Department of Clinical Bacteriology, Specialist Hospital, Gdansk, Poland
| | - Ewa Michnowska
- Department of Clinical Bacteriology, Specialist Hospital, Gdansk, Poland
| | - Julianna Kurlenda
- Department of Clinical Bacteriology, Regional Hospital, Koszalin, Poland
| | - Mariusz Grinholc
- Intercollegiate Faculty of Biotechnology, University of Gdansk and Medical University of Gdansk, Department of Biotechnology, Laboratory of Molecular Diagnostics, Gdansk, Poland
| | - Joanna Nakonieczna
- Intercollegiate Faculty of Biotechnology, University of Gdansk and Medical University of Gdansk, Department of Biotechnology, Laboratory of Molecular Diagnostics, Gdansk, Poland
| | - Krzysztof Piotr Bielawski
- Intercollegiate Faculty of Biotechnology, University of Gdansk and Medical University of Gdansk, Department of Biotechnology, Laboratory of Molecular Diagnostics, Gdansk, Poland,*To whom correspondence should be addressed: Krzysztof Piotr Bielawski, Intercollegiate Faculty of Biotechnology University of Gdansk and Medical University of Gdansk, Department of Biotechnology, Laboratory of Molecular Diagnostics, Kladki 24, 80-822 Gdansk, Poland, Phone: +48 58 523 63 14, Fax: +48 58 523 64 26, E-mail:
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First report of methicillin-resistant Staphylococcus aureus Cordobes/Chilean clone involved in nosocomial infections in Brazil. Epidemiol Infect 2011; 140:1372-5. [PMID: 22008212 DOI: 10.1017/s095026881100210x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
SUMMARY Methicillin-resistant Staphylococcus aureus (MRSA) commonly causes infection in hospitalized patients. Resistance is due to the acquisition of mecA gene located on the chromosomal element SCCmec and to date 12 types have been identified. Specific epidemic clones of MRSA have emerged with enhanced ability to spread within and among hospitals and to cross national boundaries. We studied 30 isolates from patients with MRSA infections at two hospitals in Porto Alegre city from April to December, 2008 and determined their SCCmec type by PCR. Representative strains were typed by PFGE. Eighteen (60%) isolates carried SCCmec type III and had PFGE profiles clonally related to the previously characterized Brazilian epidemic clone, and 11 (36·7%) isolates with pulsotypes closely related to the Cordobes/Chilean clone harboured SCCmec type I. To the best of our knowledge, this is the first report of the appearance of Cordobes/Chilean clone involved in nosocomial infection in Brazil.
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Barbagelata MS, Alvarez L, Gordiola M, Tuchscherr L, von Eiff C, Becker K, Sordelli D, Buzzola F. Auxotrophic mutant of Staphylococcus aureus interferes with nasal colonization by the wild type. Microbes Infect 2011; 13:1081-90. [PMID: 21784166 DOI: 10.1016/j.micinf.2011.06.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2010] [Revised: 05/04/2011] [Accepted: 06/29/2011] [Indexed: 10/18/2022]
Abstract
Staphylococcus aureus nasal carriage is a risk factor for infection in humans, particularly in the hospital setting. Bacterial interference was used as an alternative strategy for the prevention of upper respiratory, urogenital and gastrointestinal tract infections. This study was designed to assess if the administration of a live-attenuated aroA mutant of S. aureus is useful as a potential approach to prevent transient staphylococcal nasal carriage by virulent strains. We constructed an aroA mutant of S. aureus Newman strain by homologous recombination. The auxotrophic NK41 mutant was attenuated as determined by the increase of the LD(50) after intraperitoneal challenge. In mice, previous nasal colonization with the NK41 mutant significantly reduced the number of CFU of S. aureus (HU-71 and Hde288) clinical isolates and the parental Newman strain. The NK41 mutant was unable to induce a pro-inflammatory response and to damage the invaded human respiratory epithelial cells. Moreover, the cells previously or simultaneously infected with the NK41 mutant were invaded by virulent strains in a significantly lower degree than those of the control group. In conclusion, the attenuated NK41 mutant interfered with the colonization and establishment of pathogenic strains of S. aureus, which produce severe infections.
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Affiliation(s)
- María Sol Barbagelata
- Departamento de Microbiología, Parasitología e Inmunología, Facultad de Medicina, Universidad de Buenos Aires, Argentina
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Current diagnostic tools for methicillin-resistant Staphylococcus aureus infections. Mol Diagn Ther 2010; 14:73-80. [PMID: 20359250 DOI: 10.1007/bf03256356] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) is a common pathogen responsible for a wide spectrum of healthcare-associated and community-acquired infections. Infections with MRSA strains that are resistant to beta-lactams and other types of antibiotics are a serious therapeutic problem - first, because in such cases only a limited spectrum of antibiotics can be used; and second, because such infections require prolonged hospitalization and result in economic losses. Therefore, in order to limit the overspread of pathogens, the development of diagnostic tools enabling rapid identification of carriers and infected patients, as well as proper identification of drug-resistance mechanisms to enable development of more targeted clinical treatment, are vital. This article reviews the current knowledge concerning prospective diagnostics of MRSA infections.
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Reyes J, Rincón S, Díaz L, Panesso D, Contreras GA, Zurita J, Carrillo C, Rizzi A, Guzmán M, Adachi J, Chowdhury S, Murray BE, Arias CA. Dissemination of methicillin-resistant Staphylococcus aureus USA300 sequence type 8 lineage in Latin America. Clin Infect Dis 2010; 49:1861-7. [PMID: 19911971 DOI: 10.1086/648426] [Citation(s) in RCA: 104] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Methicillin-resistant Staphylococus aureus (MRSA) is an important nosocomial and community-associated (CA) pathogen. Recently, a variant of the MRSA USA300 clone emerged and disseminated in South America, causing important clinical problems. METHODS S. aureus isolates were prospectively collected (2006-2008) from 32 tertiary hospitals in Colombia, Ecuador, Peru, and Venezuela. MRSA isolates were subjected to antimicrobial susceptibility testing and pulsed-field gel electrophoresis and were categorized as health care-associated (HA)-like or CA-like clones on the basis of genotypic characteristics and detection of genes encoding Panton-Valentine leukocidin and staphylococcal cassette chromosome (SCC) mec IV. In addition, multilocus sequence typing of representative isolates of each major CA-MRSA pulsotype was performed, and the presence of USA300-associated toxins and the arcA gene was investigated for all isolates categorized as CA-MRSA. RESULTS A total of 1570 S. aureus were included; 651 were MRSA (41%)--with the highest rate of MRSA isolation in Peru (62%) and the lowest in Venezuela (26%)--and 71%, 27%, and 2% were classified as HA-like, CA-like, and non-CA/HA-like clones, respectively. Only 9 MRSA isolates were confirmed to have reduced susceptibility to glycopeptides (glycopeptide-intermediate S. aureus phenotype). The most common pulsotype (designated ComA) among the CA-like MRSA strains was found in 96% of isolates, with the majority (81%) having a < or =6-band difference with the USA300-0114 strain. Representative isolates of this clone were sequence type 8; however, unlike the USA300-0114 strain, they harbored a different SCCmec IV subtype and lacked arcA (an indicator of the arginine catabolic mobile element). CONCLUSION A variant CA-MRSA USA300 clone has become established in South America and, in some countries, is endemic in hospital settings.
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Affiliation(s)
- Jinnethe Reyes
- Molecular Genetics and Antimicrobial Resistance Unit, Universidad El Bosque, Bogota, Colombia
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Rodríguez-Noriega E, Seas C, Guzmán-Blanco M, Mejía C, Alvarez C, Bavestrello L, Zurita J, Labarca J, Luna CM, Salles MJC, Gotuzzo E. Evolution of methicillin-resistant Staphylococcus aureus clones in Latin America. Int J Infect Dis 2010; 14:e560-6. [PMID: 20047848 DOI: 10.1016/j.ijid.2009.08.018] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2008] [Revised: 05/22/2009] [Accepted: 08/25/2009] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES Methicillin-resistant Staphylococcus aureus (MRSA) is a prominent nosocomial bacterial pathogen, associated with significant morbidity and mortality. The global incidence is increasing, and Latin America is no exception. This article reviews MRSA clonal distribution in Latin America and implications for clinical practice. DESIGN A PubMed literature search (1966-2008) identified 32 articles that characterized MRSA clones in Latin America. RESULTS Data from these articles show that since 1990, several epidemic MRSA clones have spread in Latin America. The multidrug-resistant Brazilian clone is widespread, especially in Brazil and Argentina, but more recently clones with susceptibility to a range of antibiotics have been detected in Brazil, whereas in Argentina, as in Chile, Colombia and Paraguay, the multidrug-resistant Cordobes/Chilean clone prevails. In Mexico, the New York/Japan clone is most frequent. Data were not available from every country and, despite the increasing prevalence of community MRSA infections, most were collected from tertiary care centers. CONCLUSIONS A variety of epidemic MRSA clones are circulating in Latin America, some of which harbor genes that encode multidrug resistance or enhanced pathogenicity. Continued collection and reporting of epidemiological data is crucial for effective prevention and treatment.
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Affiliation(s)
- Eduardo Rodríguez-Noriega
- Hospital Civil de Guadalajara, Fray Antonio Alcalde, Instituto de Patología Infecciosa y Experimental, Centro Universitario Ciencias de la Salud, Universidad de Guadalajara, Jalisco, Mexico.
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Characterization of baseline methicillin-resistant Staphylococcus aureus isolates recovered from phase IV clinical trial for linezolid. J Clin Microbiol 2009; 48:568-74. [PMID: 19940054 DOI: 10.1128/jcm.01384-09] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
A total of 565 methicillin-resistant Staphylococcus aureus (MRSA) isolates were collected mostly from Europe and the Americas (2004 to 2007) during a phase IV clinical trial comparing linezolid with vancomycin for the treatment of complicated skin and skin structure infections proven to be due to MRSA. The isolates were tested for their susceptibilities by the broth microdilution method, they were tested for inducible clindamycin resistance by the D-test, and they were screened for heterogeneous resistance to vancomycin (heterogeneously vancomycin-intermediate S. aureus [hVISA]) by the Etest macromethod. The isolates were evaluated for the MRSA genotype by pulsed-field gel electrophoresis, staphylococcal protein A (spa) typing, multilocus sequence typing (MLST), and staphylococcal cassette chromosome mec (SCCmec) typing. All isolates were inhibited by 4 microg/ml of linezolid (MIC(50) and MIC(90), 2 and 4 microg/ml, respectively). The vast majority of isolates (92.4%) were resistant to erythromycin, and high clindamycin resistance rates were observed (28.5% constitutive and 16.3% inducible). Only 1.0% of the isolates were hVISA. Isolates from the United States were predominantly USA300 sequence type 8 (ST8)-SCCmec type IV (78.5%), followed by a lower prevalence of USA100 ST5-SCCmec type II isolates (14.2%). Strains belonging to the ST5 lineage were widely distributed in Portugal, South American countries, and Mexico. MRSA strains belonging to ST8-SCCmec type IV predominated in Russia (80.0%) and also emerged in Venezuela and Colombia. The epidemic MRSA type 15 clone predominated in the United Kingdom (55.6%) and Spain (100%). In addition, a new MLST profile (ST1071) was observed in South Africa. This study demonstrated the presence of major clones in particular regions (ST8 in the United States, ST5 in Latin America and Portugal, ST22 in Spain and the United Kingdom); however, emerging clones were identified, suggesting that the epidemiology of MRSA continues to evolve.
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Gardella N, von Specht M, Cuirolo A, Rosato A, Gutkind G, Mollerach M. Community-associated methicillin-resistant Staphylococcus aureus, eastern Argentina. Diagn Microbiol Infect Dis 2008; 62:343-7. [DOI: 10.1016/j.diagmicrobio.2008.07.008] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2008] [Revised: 06/30/2008] [Accepted: 07/05/2008] [Indexed: 10/21/2022]
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26
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Bantar C, Famiglietti A, Radice M, Quinteros M. A 7-year national survey on bacterial resistance in bronchoalveolar lavage from patients hospitalized in Argentina. Diagn Microbiol Infect Dis 2008; 60:65-9. [PMID: 17888608 DOI: 10.1016/j.diagmicrobio.2007.07.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2007] [Revised: 07/02/2007] [Accepted: 07/07/2007] [Indexed: 11/16/2022]
Abstract
The purpose of this study is to undertake a nationwide survey on bacterial resistance in bronchoalveolar lavage (BAL) from patients hospitalized in Argentina. A 2-month point prevalence study was conducted twice yearly (April-May and October-November) from 1997 to 2003 by 36 Argentinean centers. Antimicrobial susceptibility data of the potential pathogens recovered from the BAL (samples containing <1% of squamous epithelial cells and bacterial counts >or=10(4) CFU/mL) of inpatients (i.e., >or=48-h hospital length of stay) with suspected hospital-acquired pneumonia (HAP) were collected on a computerized system (SIR) described previously. The survey was split into 2 periods for comparison purposes, 1997 to 2000 and 2001 to 2003. A total of 752 organisms were included. Staphylococcus aureus was the most frequent species, followed by Acinetobacter spp. and Pseudomonas aeruginosa. In both periods, more than a half of the Klebsiella pneumoniae strains displayed a phenotype of extended-spectrum beta-lactamase producer. A doubling of imipenem-resistant Acinetobacter frequency was shown from the 1st period to the 2nd one (25-48%). More than two-thirds of the S. aureus strains proved to be methicillin resistant in both periods, and a pronounced decrease of resistance rates to trimethoprim/sulfamethoxazole and rifampin was shown in the 2nd period. The present study shows the worrisome increasing bacterial resistance in BAL samples to most available antimicrobial options for treating patients with suspected HAP. Variations over time support the need for systematic tailored surveillance and compel us to establish a rational usage of antimicrobial agents in our country.
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Affiliation(s)
- Carlos Bantar
- Sociedad Argentina de Bacteriología, Asociación Argentina de Microbiología, Buenos Aires, Argentina
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27
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Mayor L, Ortellado J, Menacho C, Lird G, Courtier C, Gardon C, Meugnier H, Bes M, Vandenesch F, Etienne J. Molecular characterization of methicillin-resistant Staphylococcus aureus isolates collected in Asunción, Paraguay. J Clin Microbiol 2007; 45:2298-300. [PMID: 17522274 PMCID: PMC1933013 DOI: 10.1128/jcm.00040-07] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
We characterized 34 methicillin-resistant Staphylococcus aureus strains isolated in Paraguay in 2005. The strains belonged to two clones. The major clone (sequence type 5 [ST5] or ST221, spa type t149, staphylococcal cassette chromosome mec [SCCmec] type I) was similar to the Cordobes/Chilean clone spreading through South America, and the minor clone (ST239 or ST889, spa type t037, SCCmec type IIIA) was related to the Brazilian clone.
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Affiliation(s)
- Lys Mayor
- Microbiology Department, Central Laboratory, Hospital de Clinicas, Asunción, Paraguay, Université Lyon 1, Centre National de Référence des Staphylocoques, Faculté Laennec, F-69008 Lyon, France
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28
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Petersdorf S, Oberdorfer K, Wendt C. Longitudinal study of the molecular epidemiology of methicillin-resistant Staphylococcus aureus at a university hospital. J Clin Microbiol 2006; 44:4297-302. [PMID: 17021064 PMCID: PMC1698402 DOI: 10.1128/jcm.01168-06] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Surveillance for methicillin-resistant Staphylococcus aureus (MRSA) at the University Hospital of Heidelberg revealed an increase in the numbers of newly detected MRSA isolates in recent years. We conducted a study to assess the dynamics of the changes in the MRSA population. Pulsed-field gel electrophoresis (PFGE) typing of MRSA isolates from all patients at the University Hospital of Heidelberg collected between 1993 and 2004 was performed. The microbiology database contained 1,807 entries for newly detected MRSA isolates from 1,301 patients. A total of 1,252 isolates were available for PFGE typing. The isolates could be classified into 109 different PFGE types. Most PFGE types (n=70) were detected less than five times and showed no evidence of transmission (sporadic strains). They accounted for 8.7% of all isolates, with few variations in frequency over the time. Thirty-seven PFGE types were clustered by time of detection, and transmission of the strains was likely (local epidemic strains). A total of 37.3% of the isolates belonged to this group of strains. The remaining 54.0% of the isolates belonged to only two further PFGE types (endemic strains). One endemic strain accounted for 5.0% of all isolates in 1994 and 68.2% in 2004. A second endemic strain was detected in 1.1% of all isolates in 1998 but in 12.4% in 2004. Statistical analysis of the associations between the kind of strain (sporadic, local epidemic, or endemic) and the patients' characteristics revealed a significant association for age and mode of acquisition. The remarkable increase in the rate of MRSA detection at the University Hospital of Heidelberg is mainly due to the dissemination of two different strains. Infection control measures seemed sufficient to prevent further transmission of some but not all of the strains.
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Affiliation(s)
- Sabine Petersdorf
- Hygiene Institut, University of Heidelberg, INF 324, 69120 Heidelberg, Germany
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Sola C, Cortes P, Saka HA, Vindel A, Bocco JL. Evolution and molecular characterization of methicillin-resistant Staphylococcus aureus epidemic and sporadic clones in Cordoba, Argentina. J Clin Microbiol 2006; 44:192-200. [PMID: 16390969 PMCID: PMC1351928 DOI: 10.1128/jcm.44.1.192-200.2006] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Since 1999, a new, epidemic, methicillin-resistant Staphylococcus aureus (MRSA) strain, named the "Cordobes clone," has emerged in Argentina and coexists with the pandemic Brazilian clone. The purpose of this study was to determine the stability over time of the new clone and to investigate its evolutionary relationship with epidemic international MRSA lineages and with other MRSA and methicillin-susceptible S. aureus (MSSA) major clones distributed in this region. One hundred three MRSA isolates recovered in 2001 from Cordoba, Argentina, hospitals and 31 MSSA strains collected from 1999 to 2002 were analyzed by their antibiotic resistance patterns, phage typing, and pulsed-field gel electrophoresis. Additionally, representative members of most MRSA defined genotypes (A, B, C, E, K, and I) were characterized by multilocus sequence typing (MLST) and spaA and SCCmec typing. The most prevalent MSSA pulsotypes were also analyzed by MLST. Our results support the displacement of the Brazilian clone (sequence type [ST] 239, spaA type WGKAOMQ, SCCmec type IIIA) by the Cordobes clone (ST5, spaA type TIMEMDMGMGMK, SCCmec type I) in the hospital environment. MRSA and MSSA isolates shared only ST5. The data support the origin of the Cordobes clone as a member of a lineage that includes the pediatric and New York/Japan international clones and that is genetically related to the British EMRSA-3 strain. Interestingly, the pediatric clone, isolated from most community-acquired infections in Cordoba, was characterized by ST100, a single-locus variant of ST5 and a new variant of SCCmec type related to SCCmec type IVc.
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Affiliation(s)
- Claudia Sola
- Departamento de Bioquímica Clínica, Facultad de Ciencias Químicas, Universidad Nacional de Córdoba, Argentina
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Rybak MJ, LaPlante KL. Community-Associated Methicillin-ResistantStaphylococcus aureus: A Review. Pharmacotherapy 2005; 25:74-85. [PMID: 15767223 DOI: 10.1592/phco.25.1.74.55620] [Citation(s) in RCA: 92] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) is a common bacterial pathogen responsible for a variety of infections in both children and adults. Treatment of infections caused by this organism is problematic due to its resistance to many drugs. Recent reports of community-associated MRSA (CA-MRSA) infections in patients with no known risk factors have serious public health implications. Therapeutic options for these infections are untested; therefore, the potential exists for high morbidity and mortality. Recently, clinical definitions have been established, and new molecular approaches have allowed investigators to distinguish CA-MRSA more easily from traditional nosocomial-derived MRSA strains. Identifying potential risk factors for CA-MRSA acquisition and fully characterizing the epidemiologic, clinical, and molecular properties of these strains are necessary to provide effective therapeutic guidelines.
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Affiliation(s)
- Michael J Rybak
- Anti-Infective Research Laboratory, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, and the School of Medicine, Wayne State University, Detroit, Michigan 48201, USA.
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Beretta ALRZ, Trabasso P, Stucchi RB, Moretti ML. Use of molecular epidemiology to monitor the nosocomial dissemination of methicillin-resistant Staphylococcus aureus in a University Hospital from 1991 to 2001. Braz J Med Biol Res 2004; 37:1345-51. [PMID: 15334200 DOI: 10.1590/s0100-879x2004000900009] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) has been the cause of major outbreaks and epidemics among hospitalized patients, with high mortality and morbidity rates. We studied the genomic diversity of MRSA strains isolated from patients with nosocomial infection in a University Hospital from 1991 to 2001. The study consisted of two periods: period I, from 1991 to 1993 and period II from 1995 to 2001. DNA was typed by pulsed-field gel electrophoresis and the similarity among the MRSA strains was determined by cluster analysis. During period I, 73 strains presented five distinctive DNA profiles: A, B, C, D, and E. Profile A was the most frequent DNA pattern and was identified in 55 (75.3%) strains; three closely related and four possibly related profiles were also identified. During period II, 80 (68.8%) of 117 strains showed the same endemic profile A identified during period I, 18 (13.7%) closely related profiles and 18 (13.7%) possibly related profiles and, only one strain presented an unrelated profile. Cluster analysis showed a 96% coefficient of similarity between profile A from period I and profile A from period II, which were considered to be from the same clone. The molecular monitoring of MRSA strains permitted the determination of the clonal dissemination and the maintenance of a dominant endemic strain during a 10-year period and the presence of closely and possibly related patterns for endemic profile A. However, further studies are necessary to improve the understanding of the dissemination of the endemic profile in this hospital.
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Affiliation(s)
- A L R Z Beretta
- Laboratório de Epidemiologia Molecular e Moléstias Infecciosas, Divisão de Moléstias Infecciosas, Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas, SP, Brasil
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Young LS, Perdreau-Remington F, Winston LG. Clinical, Epidemiologic, and Molecular Evaluation of a Clonal Outbreak of Methicillin‐ResistantStaphylococcus aureusInfection. Clin Infect Dis 2004; 38:1075-83. [PMID: 15095210 DOI: 10.1086/382361] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2003] [Accepted: 12/01/2003] [Indexed: 11/03/2022] Open
Abstract
San Francisco General Hospital (San Francisco, CA) experienced an overall increase in the recovery of methicillin-resistant Staphylococcus aureus (MRSA) isolates that were shown by pulsed-field gel electrophoresis to have a genotype (genotype A1) that was new to this institution. We performed a case-control study to identify risk factors for acquiring genotype A1 MRSA infection from 1 October 2001 to 19 July 2002. Patients with genotype A1 MRSA infection were compared with 2 control groups: MRSA-infected control patients (i.e., patients with infection due to non-genotype A1 MRSA) and non-MRSA infected control patients (i.e., hospitalized patients without MRSA infection). There were 41 case patients infected with genotype A1 MRSA, 99 control patients infected with MRSA, and 41 control patients without MRSA infection. Pneumonia, surgical wound infections, and line infections occurred more frequently among case patients. Intensive care unit exposure and invasive procedures conferred the greatest risk for genotype A1 MRSA infection in multivariate models. Case patients were not associated with increased mortality, after adjusting for age, comorbidities, and intensive care unit exposure. Genotype A1 MRSA caused a large nosocomial outbreak of infection that was associated with distinct risk factors and clinical manifestations.
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Affiliation(s)
- Lisa S Young
- Department of Medicine, Division of Infectious Diseases, University of California, San Francisco, California, USA
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Quelle LS, Corso A, Galas M, Sordelli DO. STAR gene restriction profile analysis in epidemiological typing of methicillin-resistant Staphylococcus aureus: description of the new method and comparison with other polymerase chain reaction (PCR)-based methods. Diagn Microbiol Infect Dis 2003; 47:455-64. [PMID: 14596963 DOI: 10.1016/s0732-8893(03)00137-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
A method based on restriction profile analysis of the STAR repetitive element PCR (STAR-RP PCR) product obtained by digestion with AluI and Tru9I was developed for typing methicillin resistant Staphylococcus aureus (MRSA). We evaluated a well defined collection of MRSA from Argentina, previously characterized by PFGE (pulsed field gel electrophoresis) of chromosomal SmaI digests and hybridization with DNA probes for probes ClaI-mecA and ClaI-Tn554. We comparatively evaluated STAR-RP analysis with other PCR based methods such as Inter IS256-PCR, Rep-MP3 PCR and Coa-RP. The discriminatory power (D) of STAR-RP (0.86) was similar to that of PFGE (0.84) at the type level. Comparable results were obtained with Inter IS256 PCR (0.85) and Rep-MP3 PCR (0.80). A lower value (0.74) was obtained for Coa-RP. An excellent reproducibility (100%) of STAR-RP was observed. Good concordance between STAR-RP and other molecular typing methods was found for MRSA isolates (n = 39). STAR-RP typing showed 87% concordance with mecA::Tn554::PFGE, 87% with Inter IS256 PCR and 71% with Rep-MP3 typing. STAR-RP is suggested as an adequate molecular typing assay for MRSA epidemiologic assessment.
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Affiliation(s)
- Liliana S Quelle
- Departamento de Microbiología, Parasitología e Inmunología, Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires, Argentina
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