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Lee CY, Fang YP, Wu TH, Chang YF, Sung CH. Sequence types 8, 59, and 45 methicillin resistant Staphylococcus aureus as the predominant strains causing skin and soft tissue infections in Taiwan's prisons and jails. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2022; 55:1239-1245. [PMID: 34635424 DOI: 10.1016/j.jmii.2021.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 08/19/2021] [Accepted: 08/26/2021] [Indexed: 12/27/2022]
Abstract
BACKGROUND Methicillin-resistant Staphylococcus aureus (MRSA) is the predominant cause of skin and soft tissue infections (SSTIs), which is a problem in prisons and jails. We conducted this study to understand MRSA molecular characteristics among inmates with SSTIs, and we chose MRSA isolates from a community hospital as a comparison. METHODS A total of 219 MRSA isolates from three custodial facilities and 134 isolates from a community hospital in Taiwan were collected in the 2017 calendar year. MRSA isolates were investigated molecularly by staphylococcal chromosome cassette mec (SCCmec) type, mupirocin, and chlorhexidine genotypical resistance, and multi-locus sequence typing (ST). RESULTS Of the 219 MRSA isolates from custodial facilities, SCCmec IV was the most prevalent type (65.3%), followed by type VT (32.4%) and type V (1.8%). Regarding sequence types, ST59 (36.4%), 8 (35.3%), and 45 (17.9%) were the leading three predominant types out of 184 selected MRSA isolates, and ST45 MRSA was more prevalent in custodial facilities (p = 0.019). The antimicrobial resistance rates varied for different MRSA strains, with ST45 MRSA having the lowest rates of resistance to most antimicrobials. Overall, 91.5% of isolates carried mupA gene and 25.8% were positive for qacA/B gene, this was independent of the MRSA sequence types. CONCLUSIONS ST59, ST8, and ST45 MRSA are the leading three MRSA strains causing SSTIs in Taiwan, 2017, but the molecular distribution varied distinctly between the custodial facilities and hospital settings. The genotypical mupirocin resistance rate is quite high in this study. The frequency of chlorhexidine resistance gene is relatively low, especially in MRSA isolates from custodial facilities.
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Affiliation(s)
- Chun Yi Lee
- Department of Pediatrics, Chang Bing Show Chwan Memorial Hospital, Changhua, Taiwan.
| | - Yu Ping Fang
- Department of Pediatrics, Chang Bing Show Chwan Memorial Hospital, Changhua, Taiwan
| | - Tsung Hua Wu
- Department of Pediatrics, Changhua Show Chwan Memorial Hospital, Changhua, Taiwan
| | - Yu Feng Chang
- Department of Clinical Laboratory, Chang Bing Show Chwan Memorial Hospital, Changhua, Taiwan
| | - Chia Hsing Sung
- Department of Clinical Laboratory, Chang Bing Show Chwan Memorial Hospital, Changhua, Taiwan
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The European Union Summary Report on Antimicrobial Resistance in zoonotic and indicator bacteria from humans, animals and food in 2017/2018. EFSA J 2020; 18:e06007. [PMID: 32874244 PMCID: PMC7448042 DOI: 10.2903/j.efsa.2020.6007] [Citation(s) in RCA: 152] [Impact Index Per Article: 38.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Data on antimicrobial resistance (AMR) in zoonotic and indicator bacteria from humans, animals and food are collected annually by the EU Member States (MSs), jointly analysed by EFSA and ECDC and reported in a yearly EU Summary Report. The annual monitoring of AMR in animals and food within the EU is targeted at selected animal species corresponding to the reporting year. The 2017 monitoring specifically focussed on pigs and calves under 1 year of age, as well as their derived carcases/meat, while the monitoring performed in 2018 specifically focussed on poultry and their derived carcases/meat. Monitoring and reporting of AMR in 2017/2018 included data regarding Salmonella, Campylobacter and indicator Escherichia coli isolates, as well as data obtained from the specific monitoring of ESBL-/AmpC-/carbapenemase-producing E. coli isolates. Additionally, some MSs reported voluntary data on the occurrence of meticillin-resistant Staphylococcus aureus in animals and food, with some countries also providing data on antimicrobial susceptibility. This report provides, for the first time, an overview of the main findings of the 2017/2018 harmonised AMR monitoring in the main food-producing animal populations monitored, in related carcase/meat samples and in humans. Where available, data monitoring obtained from pigs, calves/cattle, broilers, laying hens and turkeys, as well as from carcase/meat samples and humans were combined and compared at the EU level, with particular emphasis on multiple drug resistance, complete susceptibility and combined resistance patterns to critically important antimicrobials, as well as Salmonella and E. coli isolates exhibiting presumptive ESBL-/AmpC-/carbapenemase-producing phenotypes. The outcome indicators for AMR in food-producing animals, such as complete susceptibility to the harmonised panel of antimicrobials in E. coli and the prevalence of ESBL-/AmpC-producing E. coli have been also specifically analysed over the period 2014-2018.
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Hanawa T, Shimoda-Komatsu Y, Araki K, Ohyama M, Ohnishi H, Kamiya S, Matsuda T. Skin and Soft Tissue Infections Caused by Different Genotypes of PVL-Positive Community-Acquired Methicillin-Resistant Staphylococcus aureus Strains. Jpn J Infect Dis 2019; 73:72-75. [PMID: 31666493 DOI: 10.7883/yoken.jjid.2019.162] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Panton-Valentine leukocidin (PVL) is a causative agent of lethal necrotizing pneumonia and is associated with epidemic strains of community-acquired (CA) methicillin-resistant Staphylococcus aureus (MRSA). PVL-producing strains have rarely been isolated in Japan. However, PVL-positive CA-MRSA has been isolated much more frequently in recent years. To investigate the relevance of pvl genes (lukS/F-PV) and clinical traits in epidemic S. aureus strains, we genotyped four PVL-positive CA-MRSA strains isolated from patients with skin and soft tissue infections and measured their susceptibility to antibiotics. Three of the isolates matched the genotype of the USA300 clone, which has predominantly been isolated in the USA. The remaining strain matched the ST217 genotype, and its spa type was identical to that of PVL-positive strains previously reported in India and China. Abscess drainage was necessary in all cases, and deep cutaneous ulcers were formed in three out of four cases regardless of the genotype. The ST217 genotype strain was resistant to clindamycin, in addition to quinolones, macrolides, and aminoglycosides. Thus, diagnostic determination of lukS/F-PV should be used as a guide for selecting the treatment regimen.
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Affiliation(s)
- Tomoko Hanawa
- Department of Infectious Diseases, Kyorin University School of Medicine
| | | | - Koji Araki
- Department of Clinical Laboratory, Kyorin University School of Medicine
| | - Manabu Ohyama
- Department of Dermatology, Kyorin University School of Medicine
| | - Hiroaki Ohnishi
- Department of Laboratory Medicine, Kyorin University School of Medicine
| | - Shigeru Kamiya
- Faculty of Health Sciences, Kyorin University School of Medicine
| | - Takeaki Matsuda
- Department of Traumatology and Critical Care Medicine, Kyorin University School of Medicine
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The European Union summary report on antimicrobial resistance in zoonotic and indicator bacteria from humans, animals and food in 2017. EFSA J 2019; 17:e05598. [PMID: 32626224 PMCID: PMC7009238 DOI: 10.2903/j.efsa.2019.5598] [Citation(s) in RCA: 157] [Impact Index Per Article: 31.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
The data on antimicrobial resistance in zoonotic and indicator bacteria in 2017, submitted by 28 EU Member States (MSs), were jointly analysed by EFSA and ECDC. Resistance in zoonotic Salmonella and Campylobacter from humans, animals and food, and resistance in indicator Escherichia coli as well as meticillin‐resistant Staphylococcus aureus in animals and food were addressed, and temporal trends assessed. ‘Microbiological’ resistance was assessed using epidemiological cut‐off (ECOFF) values; for some countries, qualitative data on human isolates were interpreted in a way which corresponds closely to the ECOFF‐defined ‘microbiological’ resistance. In Salmonella from humans, as well as in Salmonella and E. coli isolates from fattening pigs and calves of less than 1 year of age, high proportions of isolates were resistant to ampicillin, sulfonamides and tetracyclines, whereas resistance to third‐generation cephalosporins was uncommon. Varying occurrence/prevalence rates of presumptive extended‐spectrum beta‐lactamase (ESBL)/AmpC producers in Salmonella and E. coli monitored in meat (pork and beef), fattening pigs and calves, and Salmonella monitored in humans, were observed between countries. Carbapenemase‐producing E. coli were detected in one single
sample from fattening pigs in one MS. Resistance to colistin was observed at low levels in Salmonella and E. coli from fattening pigs and calves and meat thereof and in Salmonella from humans. In Campylobacter from humans, high to extremely high proportions of isolates were resistant to ciprofloxacin and tetracyclines, particularly in Campylobacter coli. In five countries, high to very high proportions of C. coli from humans were resistant also to erythromycin, leaving few options for treatment of severe Campylobacter infections. High resistance to ciprofloxacin and tetracyclines was observed in C. coli isolates from fattening pigs, whereas much lower levels were recorded for erythromycin. Combined resistance to critically important antimicrobials in both human and animal isolates was generally uncommon but very high to extremely high multidrug resistance levels were observed in S. Typhimurium and its monophasic variant in both humans and animals. S. Kentucky from humans exhibited high‐level resistance to ciprofloxacin, in addition to a high prevalence of ESBL.
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Impact of mass migrations on the clonal variation of clinical Staphylococcus aureus strains isolated from the Western region of Saudi Arabia. J Infect Public Health 2018; 12:317-322. [PMID: 30477918 DOI: 10.1016/j.jiph.2018.11.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Revised: 10/17/2018] [Accepted: 11/04/2018] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES A rapid molecular typing system was used to determine the impact of mass migration on the clonal variation of Staphylococcus aureus isolates recovered from King Abdulaziz University Hospital (KAUH) Jeddah, in the western region of Saudi Arabia. This region experiences an annual influx of millions of pilgrims. METHODS SmaI-multiplex PCR typing (SMT) was used for the initial analysis of strains and the resulting data subsequently supported by Multi-Locus Sequence Typing (MLST). RESULTS A total of 89 S. aureus isolates were SMT typed and revealed a high degree of genetic variation, with 40 SMT profiles detected among the isolates. Representatives of all forty SMT types were subsequently analysed by MLST, identifying 26 sequence types. A novel sequence type (ST), named ST3303, was identified in two methicillin-sensitive S. aureus (MSSA) isolates. MSSA strains exhibited more diversity than methicillin-resistant S. aureus (MRSA) strains, with community acquired MSSA and MRSA strains reaching alarmingly high levels. CONCLUSION The relatively high degree of genetic diversity found among S. aureus isolates of single hospital was attributed to the fact that Jeddah is the principal gateway to Mecca, visited each year by millions of pilgrims from many countries. The observed diversity clearly reflects the impact of such mass migrations in the rapid dissemination of strains world-wide. Our findings suggest the importance of surveillance programmes in locations affected by mass migrations, both to monitor their impact on endemic strains and for the detection of pandemic strains. SMT provides a cost-effective and sensitive typing method for achieving this objective.
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Ekinci B, Edgunlu TG, Bayramoglu G, Atay GU. Molecular investigation of staphylococcal cassette chromosome mec types and genotypic relations of methicillin-resistant staphylococci isolated from before and after hospital exposed students. Indian J Med Microbiol 2018; 36:257-264. [PMID: 30084421 DOI: 10.4103/ijmm.ijmm_17_256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background Reservoir of methicillin resistance genes called staphylococcal cassette chromosome mec (SCCmec), plasmids and genomic characterisations of isolates have been widely investigated in epidemiologic research. However, the extent to which these organisms are transported by patients or hospital staff is not entirely clear. Aim This study aims to investigate the molecular relatedness and plasmid profiles of MR staphylococci isolated from nursing students before and after hospital training, to find out the possible source. Materials and Methods This study examined 39 methicillin-resistant (MR) staphylococci and 2 inducible clindamycin-resistant, methicillin-susceptible Staphylococcus aureus. Specimens were collected before and after 4 months of hospital training from the hands and nares of 75 nursing students. A polymerase chain reaction technique was used to confirm the existence of mecA gene and identify SCCmec types; total DNA was digested by SmaI endonuclease restriction to monitorise clonal relatedness by pulsed-field gel electrophoresis (PFGE); plasmid profiles were monitorised on agarose gel. Results All 39 isolates tested positive for mecA; SCCmec type III was observed most frequently. Interestingly, in one isolate of Staphylococcus epidermidis, four different types of SCCmec elements were observed. There were 23 different types of plasmids, whose sizes ranged from 1.4 to 46.0 kb. After PFGE dendogram analysis, two strains were classified as indistinguishable; six were closely related. Most of the isolates obtained after hospital training showed clonal similarity and seven had multiple SCCmec elements require further investigation for the possible mechanism. Conclusion Most of the isolates obtained after hospital training showed clonal similarity and seven had multiple SCCmec elements require further investigation for the possible mechanism.
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Affiliation(s)
- Bora Ekinci
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Mugla Sitki Kocman University, Mugla, Turkey
| | - Tuba Gokdogan Edgunlu
- Department of Medical Biology, Faculty of Medicine, Mugla Sitki Kocman University, Mugla, Turkey
| | - Gulcin Bayramoglu
- Department of Medical Microbiology, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey
| | - Gulsen Ulucam Atay
- Department of Medical Microbiology, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey
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Huang YT, Liao CH, Chen SY, Hsu HS, Teng LJ, Hsueh PR. Emergence of multidrug-resistant sequence type 45 strains among mecA-positive borderline oxacillin-resistant Staphylococcus aureus causing bacteraemia in a medical centre in Taiwan. Int J Antimicrob Agents 2018; 52:70-75. [PMID: 29505885 DOI: 10.1016/j.ijantimicag.2018.02.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Revised: 02/01/2018] [Accepted: 02/17/2018] [Indexed: 11/20/2022]
Abstract
Clinical data related to bacteraemia caused by mecA-positive borderline oxacillin-resistant Staphylococcus aureus (BORSA) isolates [minimum inhibitory concentrations (MICs) of 0.5-4 mg/L] are limited. Patients aged ≥15 years with bacteraemia due to BORSA who were admitted to the emergency department of a Taiwanese tertiary hospital between January 2001 and December 2015 were evaluated. Clinical characteristics of patients with bacteraemia caused by BORSA, methicillin-susceptible S. aureus and methicillin-resistant S. aureus (MRSA) were compared. MICs of 12 antibiotics were determined by agar dilution. Genetic characteristics of 64 available BORSA isolates were analysed by detection of the SCCmec gene, the mecA promoter region sequence and multilocus sequence typing (MLST). Pulsed-field gel electrophoresis (PFGE) was performed to identify the clonality of the emerging ST isolates. The quinolone resistance genes were analysed for the emerging ciprofloxacin-resistant ST45 clone isolates. Among the 65 BORSA bacteraemic patients, in-hospital mortality was 24.6%, significantly lower than that of MRSA patients (38.5%) (P = 0.03). Underlying conditions were similar between BORSA and MRSA patients, but with less dialysis in the former (P = 0.01). Multivariate analysis revealed that septic shock [odds ratio (OR) = 15.95] and bacteraemia originating from lower respiratory tract infection (OR = 5.78) were two independent risk factors for 30-day mortality. The ST45 clone with high-level ciprofloxacin resistance (MICs of 8-128 mg/L) replaced ST59 as the predominant clone since 2012, although no major clustering was detected. In conclusion, the emerging multidrug-resistant ST45 clone has replaced ST59 as the most common among BORSA isolates.
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Affiliation(s)
- Yu-Tsung Huang
- Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan; Department of Laboratory Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan; Department of Clinical Laboratory Sciences and Medical Biotechnology College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chun-Hsing Liao
- Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan; College of Medicine, Yang-Ming University, Taipei, Taiwan
| | - Shey-Ying Chen
- Department of Emergency Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Hsin-Sui Hsu
- Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Lee-Jene Teng
- Department of Laboratory Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan; Department of Clinical Laboratory Sciences and Medical Biotechnology College of Medicine, National Taiwan University, Taipei, Taiwan.
| | - Po-Ren Hsueh
- Department of Laboratory Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan; Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan.
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Peterson LR, Woods CW, Davis TE, Wang ZX, Young SA, Osiecki JC, Lewinski MA, Liesenfeld O. Performance of the cobas MRSA/SA Test for Simultaneous Detection of Methicillin-Susceptible and Methicillin-Resistant Staphylococcus aureus From Nasal Swabs. Am J Clin Pathol 2017; 148:119-127. [PMID: 28898981 DOI: 10.1093/ajcp/aqx040] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVES Health care-associated methicillin-resistant Staphylococcus aureus (MRSA) and Staphylococcus aureus (SA) infections are continuing problems. Rapidly determining the MRSA colonization status of a patient facilitates practice to reduce spread of MRSA clinical disease. Sensitive detection of all SA prior to surgery, followed by decolonization, can significantly reduce postoperative infection from this pathogen. Our goal was to validate a new automated assay for this testing. METHODS We compared performance of the cobas MRSA/SA Test on the cobas 4800 System to direct and enriched chromogenic culture using nasal swabs collected from patients at six United States sites. RESULTS Compared to direct and enriched culture, the sensitivity for MRSA and SA was 93.1% and 93.9%, and the specificity was 97.5% and 94.2%, respectively. After discrepancy analysis, the sensitivity for MRSA and SA was 97.1% and 98.6%, and the specificity was 98.3% and 95.5%, respectively. Compared to direct culture, sensitivity for detecting any SA was 99.6%. CONCLUSIONS The cobas MRSA/SA Test is an effective tool to simultaneously perform surveillance testing for nasal colonization of both MRSA and MSSA.
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Affiliation(s)
- Lance R Peterson
- Department of Laboratory Medicine and Pathology, NorthShore University HealthSystem, Evanston, IL
| | - Christopher W Woods
- Duke University Health System, Durham, NC
- Department of Veterans Affairs Medical Center, Durham, NC
| | - Thomas E Davis
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis
| | | | - Stephen A Young
- TriCore Reference Laboratories, Albuquerque, NM
- Department of Pathology, University of New Mexico HSC, Albuquerque
| | - John C Osiecki
- Medical and Scientific Affairs, Roche Molecular Diagnostics, Pleasanton, CA
| | - Michael A Lewinski
- Medical and Scientific Affairs, Roche Molecular Diagnostics, Pleasanton, CA
| | - Oliver Liesenfeld
- Medical and Scientific Affairs, Roche Molecular Diagnostics, Pleasanton, CA
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Vali L, Dashti AA, Mathew F, Udo EE. Characterization of Heterogeneous MRSA and MSSA with Reduced Susceptibility to Chlorhexidine in Kuwaiti Hospitals. Front Microbiol 2017; 8:1359. [PMID: 28775716 PMCID: PMC5517409 DOI: 10.3389/fmicb.2017.01359] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Accepted: 07/04/2017] [Indexed: 11/20/2022] Open
Abstract
The objective of this investigation was to identify the lineages of MRSA and MSSA with reduced susceptibility to chlorhexidine in Kuwaiti hospitals. 121 clinical MRSA and 56 MSSA isolates were included in this study. Antimicrobial susceptibility testing was performed for a selection of agents including chlorhexidine and resistance genes were amplified and sequenced. PFGE, spa typing, and MLST were completed for a selection of isolates. The results showed SCCmec II, III, IV, and V were present in 0.8, 21.5, 69.4, and 8.3% of the MRSA isolates. agr-1Sa was the most prevalent type in both MSSA (48%) and MRSA (54%). Forty-five percentage of MRSA contained pvl and 39% contained lukE-lukD, however, as many as 86% of MSSA contained pvl and 96.4% contained lukE-lukD. qac A-C genes were identified in 12.3% of MRSA, norA was present in 82.6% and blaZ in 94.2%. Among MSSA only 5.4% harbored qacA, 83% contained norA, and 91% blaZ. Multi-drug resistant ST239/t945 lineage containing a qac gene was the most identified S. aureus. However, other lineages, including ST772-MRSA-V/t4867/pvl(+)qacC/smr and non-qac harboring lineages of ST217-MRSAIV/t3244/pvl(-), ST34-MSSA/t161/pvl(+), ST5-MSSA/t688/pvl(+), ST5-MSSA/t4867/norA(+), and ST672-MSSA/t003/pvl(-), also showed reduced susceptibility to chlorhexidine. The observed reduced susceptibility of non-qac dependent MSSA isolates to chlorhexidine suggests the involvement of other elements in promoting higher MBC (≥30 mg/L). Our results confirm that monitoring MSSA is essential as they may have the potential to survive low level biocide exposure.
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Affiliation(s)
- Leila Vali
- Department of Medical Laboratory Sciences, Faculty of Allied Health Sciences, Kuwait UniversitySulaibekhat, Kuwait
| | - Ali A. Dashti
- Department of Medical Laboratory Sciences, Faculty of Allied Health Sciences, Kuwait UniversitySulaibekhat, Kuwait
| | - Febine Mathew
- Department of Medical Laboratory Sciences, Faculty of Allied Health Sciences, Kuwait UniversitySulaibekhat, Kuwait
| | - Edet E. Udo
- Department of Medical Microbiology, Faculty of Medicine, Kuwait UniversitySulaibekhat, Kuwait
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Sergelidis D, Angelidis AS. Methicillin-resistant Staphylococcus aureus: a controversial food-borne pathogen. Lett Appl Microbiol 2017; 64:409-418. [PMID: 28304109 DOI: 10.1111/lam.12735] [Citation(s) in RCA: 104] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Revised: 03/10/2017] [Accepted: 03/11/2017] [Indexed: 12/17/2022]
Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) is a major cause of severe healthcare-associated (HA) infections. Although during the last decade the incidence of HA invasive infections has dropped, the incidence of community-associated MRSA (CA-MRSA) infections has risen among the general population. Moreover, CA-MRSA, livestock-associated MRSA (LA-MRSA) and HA-MRSA (HA-MRSA) can be found in foods intended for human consumption. Several studies from different geographical areas have reported the presence of enterotoxin genes in several MRSA food isolates. Molecular typing studies have revealed genetic relatedness of these enterotoxigenic isolates with isolates incriminated in human infections. The contamination sources for foods, especially animal-origin foods, may be livestock as well as humans involved in animal husbandry and food-processing. Under favourable environmental conditions for growth and enterotoxin production, enterotoxigenic S. aureus isolates present in foods can cause staphylococcal food poisoning (SFP), irrespective of the contamination origin. Owing to the typically moderate clinical manifestations of SFP, the S. aureus strains responsible for SFP (cases or outbreaks) are frequently either not identified or not further characterized. Antimicrobial susceptibility testing is rarely performed, because administration of antimicrobial therapy is not required in the vast majority of cases. Staphylococcal food poisoning is the result of consumption of foods with preformed enterotoxins. Hence, similar to methicillin-sensitive enterotoxigenic S. aureus, enterotoxigenic MRSA can also act as food-borne pathogens upon favourable conditions for growth and enterotoxin production. The severity of the intoxication is not related to the antimicrobial resistance profile of the causative S. aureus strain and therefore MRSA food-borne outbreaks are not expected to be more severe. SIGNIFICANCE AND IMPACT OF THE STUDY This review evaluates the potential of methicillin-resistant Staphylococcus aureus (MRSA) as food-borne pathogens based on the current knowledge about the epidemiology of MRSA, their prevalence in livestock, foods of animal origin and humans, and their ability to produce enterotoxins.
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Affiliation(s)
- D Sergelidis
- Laboratory of Hygiene of Foods of Animal Origin, School of Veterinary Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - A S Angelidis
- Laboratory of Milk Hygiene and Technology, School of Veterinary Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Blodkamp S, Kadlec K, Gutsmann T, Quiblier C, Naim HY, Schwarz S, von Köckritz-Blickwede M. Effects of SecDF on the antimicrobial functions of cathelicidins against Staphylococcus aureus. Vet Microbiol 2017; 200:52-58. [DOI: 10.1016/j.vetmic.2016.03.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Revised: 03/29/2016] [Accepted: 03/30/2016] [Indexed: 10/22/2022]
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Costa SS, Palma C, Kadlec K, Fessler AT, Viveiros M, Melo-Cristino J, Schwarz S, Couto I. Plasmid-Borne Antimicrobial Resistance of Staphylococcus aureus Isolated in a Hospital in Lisbon, Portugal. Microb Drug Resist 2016; 22:617-626. [PMID: 27309487 DOI: 10.1089/mdr.2015.0352] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Plasmids play a key role in the genetic plasticity and survival of Staphylococcus aureus in challenging environments. Although many S. aureus plasmids have been described, still few studies portray the plasmid content of a given S. aureus population. The aim of this work was to characterize the plasmids carried by a collection of 53 S. aureus isolates collected in a large hospital in Lisbon, Portugal, and investigate their role in conferring resistance to several antimicrobial agents. Plasmids were present in 44 out of the 53 isolates and were grouped into eleven AccI restriction profiles. Plasmid curing of representative strains and comparison of antimicrobial susceptibility profiles between pairs of isogenic strains proved to be a valuable guidance tool in the identification of plasmid-located resistance genes. The plasmids harbored several resistance genes, namely blaZ (resistance to β-lactams), erm(C) (resistance to macrolides, lincosamides, and streptogramin B), cadA (resistance to cadmium and zinc), cadD (resistance to cadmium), and qacA and smr (resistance to biocides and dyes). This study demonstrates the impact of plasmids on the resistance properties of S. aureus, highlighting their role in the dissemination of antibiotic, heavy metal, and biocide resistance genes, and survival of this major pathogen in the hospital environment.
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Affiliation(s)
- Sofia Santos Costa
- 1 Global Health and Tropical Medicine, GHTM, Unidade de Microbiologia Médica, Instituto de Higiene e Medicina Tropical, IHMT, Universidade Nova de Lisboa , UNL, Lisbon, Portugal
| | - Cláudia Palma
- 1 Global Health and Tropical Medicine, GHTM, Unidade de Microbiologia Médica, Instituto de Higiene e Medicina Tropical, IHMT, Universidade Nova de Lisboa , UNL, Lisbon, Portugal
| | - Kristina Kadlec
- 2 Institute of Farm Animal Genetics , Friedrich-Loeffler-Institut (FLI), Neustadt-Mariensee, Germany
| | - Andrea T Fessler
- 2 Institute of Farm Animal Genetics , Friedrich-Loeffler-Institut (FLI), Neustadt-Mariensee, Germany
| | - Miguel Viveiros
- 1 Global Health and Tropical Medicine, GHTM, Unidade de Microbiologia Médica, Instituto de Higiene e Medicina Tropical, IHMT, Universidade Nova de Lisboa , UNL, Lisbon, Portugal
| | - José Melo-Cristino
- 3 Centro Hospitalar Lisboa Norte E.P.E., Instituto de Microbiologia, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Stefan Schwarz
- 2 Institute of Farm Animal Genetics , Friedrich-Loeffler-Institut (FLI), Neustadt-Mariensee, Germany
| | - Isabel Couto
- 1 Global Health and Tropical Medicine, GHTM, Unidade de Microbiologia Médica, Instituto de Higiene e Medicina Tropical, IHMT, Universidade Nova de Lisboa , UNL, Lisbon, Portugal
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Bouchiat C, El-Zeenni N, Chakrakodi B, Nagaraj S, Arakere G, Etienne J. Epidemiology of Staphylococcus aureus in Bangalore, India: emergence of the ST217 clone and high rate of resistance to erythromycin and ciprofloxacin in the community. New Microbes New Infect 2015; 7:15-20. [PMID: 26110062 PMCID: PMC4475830 DOI: 10.1016/j.nmni.2015.05.003] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Revised: 04/24/2015] [Accepted: 05/06/2015] [Indexed: 11/07/2022] Open
Abstract
This study aimed to determine the antibiotic susceptibility pattern of Staphylococcus aureus (SA) and the circulating clones in Bangalore, India. Susceptibility testing was performed for all cases of SA infections in a tertiary-care hospital. Panton-Valentine leucocidin (PVL) encoding genes were detected, and sequence type and spa type were determined. Out of the 92 collected strains, 52.2% were methicillin-resistant SA (MRSA), isolated from community-acquired (CA) infections in 60.4% and hospital-acquired (HA) infections in 39.6%. S. aureus isolates were also highly resistant to erythromycin (54.3%) and ciprofloxacin (70.6%) in methicillin-susceptible SA (MSSA) and MRSA, as well as in CA and HA infections. MRSA were found to be significantly more resistant to gentamicin (p <0.001), cotrimoxazole (p <0.001) and ciprofloxacin (p 0.001) than MSSA, but no significant difference was observed between CA- and HA-SA. ST217 appeared as a new emerging and prevalent clone, but ST772 remained the predominant clone, all being PVL-positive isolates. Our study points out the high prevalence of MRSA, even in the community, and the worrying increase of resistance to ciprofloxacin and erythromycin among CA-MSSA. Emergence of clone ST217 is reported for the first time in India.
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Affiliation(s)
- C Bouchiat
- Laboratoire de bactériologie, Centre de biologie Est, Hospices Civils de Lyon, Lyon, France ; Faculté de medicine, Université Claude Bernard-Lyon, Lyon, France ; Centre national de référence des staphylocoques, Lyon, France
| | - N El-Zeenni
- Laboratoire de bactériologie, Centre de biologie Est, Hospices Civils de Lyon, Lyon, France
| | - B Chakrakodi
- Society for Innovation and Development, Indian Institute of Science, Bangalore, India
| | - S Nagaraj
- St. John's Hospital and Medical College, Bangalore, India
| | - G Arakere
- Society for Innovation and Development, Indian Institute of Science, Bangalore, India
| | - J Etienne
- Laboratoire de bactériologie, Centre de biologie Est, Hospices Civils de Lyon, Lyon, France ; Laboratoire de bactériologie, Centre de biologie Est, Hospices Civils de Lyon, Lyon, France ; Faculté de medicine, Université Claude Bernard-Lyon, Lyon, France
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Ellington MJ, Reuter S, Harris SR, Holden MTG, Cartwright EJ, Greaves D, Gerver SM, Hope R, Brown NM, Török ME, Parkhill J, Köser CU, Peacock SJ. Emergent and evolving antimicrobial resistance cassettes in community-associated fusidic acid and meticillin-resistant Staphylococcus aureus. Int J Antimicrob Agents 2015; 45:477-84. [PMID: 25769787 PMCID: PMC4415905 DOI: 10.1016/j.ijantimicag.2015.01.009] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Accepted: 01/12/2015] [Indexed: 11/19/2022]
Abstract
Fusidic acid is a topical and systemic antimicrobial used for the treatment of staphylococcal infections in hospitals and the community. Sales of fusidic acid and resistance rates among meticillin-resistant Staphylococcus aureus (MRSA) doubled between 1990 and 2001. For the following decade, fusidic acid resistance rates among isolates from Addenbrooke's Hospital (Cambridge, UK) were compared with national resistance rates from MRSA bacteraemia surveillance data and with antimicrobial sales data. Sales of fusidic acid remained relatively constant between 2002 and 2012, whilst fusidic acid resistance increased two- and four-fold in MRSA bacteraemias nationally and in MRSA isolates from Cambridge, respectively. A subgroup of MRSA resistant only to fusidic acid increased after 2006 by 5-fold amongst bacteraemias nationally and 17-fold (to 7.7% in 2012) amongst Cambridge MRSA isolates. All of the available local isolates from 2011 to 2012 (n=23) were acquired in the community, were not related epidemiologically and belonged to multilocus sequence typing (MLST) groups ST1, 5, 8, 45 or 149 as revealed from analysis of whole-genome sequence data. All harboured the fusC gene on one of six distinct staphylococcal cassette chromosome (SCC) elements, four of which were dual-resistance chimeras that encoded β-lactam and fusidic acid resistance. In summary, fusidic acid-resistant MRSA increased in prevalence during the 2000s with notable rises after 2006. The development of chimeric cassettes that confer dual resistance to β-lactams and fusidic acid demonstrates that the genetics underpinning resistance in community-associated MRSA are evolving.
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Affiliation(s)
- Matthew J Ellington
- Public Health England, Microbiology Services Division, Addenbrooke's Hospital, Hills Road, Cambridge CB2 0QW, UK; Wellcome Trust Sanger Institute, Wellcome Trust Genome Campus, Hinxton, Cambridge CB10 1SA, UK.
| | - Sandra Reuter
- Wellcome Trust Sanger Institute, Wellcome Trust Genome Campus, Hinxton, Cambridge CB10 1SA, UK
| | - Simon R Harris
- Wellcome Trust Sanger Institute, Wellcome Trust Genome Campus, Hinxton, Cambridge CB10 1SA, UK
| | - Matthew T G Holden
- Wellcome Trust Sanger Institute, Wellcome Trust Genome Campus, Hinxton, Cambridge CB10 1SA, UK
| | - Edward J Cartwright
- Department of Medicine, University of Cambridge, Addenbrooke's Hospital, Hills Road, Cambridge CB2 0QW, UK
| | - Daniel Greaves
- Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, UK
| | - Sarah M Gerver
- Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK
| | - Russell Hope
- Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK
| | - Nicholas M Brown
- Public Health England, Microbiology Services Division, Addenbrooke's Hospital, Hills Road, Cambridge CB2 0QW, UK; Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, UK
| | - M Estee Török
- Public Health England, Microbiology Services Division, Addenbrooke's Hospital, Hills Road, Cambridge CB2 0QW, UK; Department of Medicine, University of Cambridge, Addenbrooke's Hospital, Hills Road, Cambridge CB2 0QW, UK; Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, UK
| | - Julian Parkhill
- Wellcome Trust Sanger Institute, Wellcome Trust Genome Campus, Hinxton, Cambridge CB10 1SA, UK
| | - Claudio U Köser
- Department of Medicine, University of Cambridge, Addenbrooke's Hospital, Hills Road, Cambridge CB2 0QW, UK
| | - Sharon J Peacock
- Public Health England, Microbiology Services Division, Addenbrooke's Hospital, Hills Road, Cambridge CB2 0QW, UK; Wellcome Trust Sanger Institute, Wellcome Trust Genome Campus, Hinxton, Cambridge CB10 1SA, UK; Department of Medicine, University of Cambridge, Addenbrooke's Hospital, Hills Road, Cambridge CB2 0QW, UK; Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, UK
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15
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Vignaroli C, Mancini A, Varaldo PE. Composite SCCmec element in single-locus variant (ST217) of epidemic MRSA-15 clone. Emerg Infect Dis 2014; 20:905-7. [PMID: 24751207 PMCID: PMC4012794 DOI: 10.3201/eid2005.130934] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
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16
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Hernández-Porto M, Lecuona M, Aguirre-Jaime A, Castro B, Delgado T, Cuervo M, Pedroso Y, Arias Á. Antimicrobial resistance and molecular analysis of methicillin-resistant Staphylococcus aureus collected in a Spanish hospital. Microb Drug Resist 2014; 21:201-8. [PMID: 25365597 DOI: 10.1089/mdr.2014.0139] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Clonal distribution of methicillin-resistant Staphylococcus aureus (MRSA) in hospitals may differ according to the geographic location and time period. Knowledge of MRSA clonal epidemiology in hospital settings involves much more than the study of healthcare-associated MRSA (HA-MRSA) clones. In recent years, investigators have documented the introduction of both community-associated MRSA (CA-MRSA) and livestock-associated MRSA (LA-MRSA) clones, the emergence of clones carrying Staphylococcal cassette chromosome mec (SCCmec) XI, and the genetic diversity among sporadic MRSA isolates. The allocation of certain antibiotypes to dominant MRSA clones in an institution allows their use as phenotypic markers for a preliminary search for new clones, early detection of clonal shift, and as a guide for better empirical therapy, infection control, and treatment within a particular institution. For these reasons, we identified 938 strains detected in a System of Universal Active Surveillance of MRSA in clinical samples during the period 2009-2010, obtaining the clonal distribution of MRSA at the Hospital Universitario de Canarias (Tenerife, Spain) and the relationship between antimicrobial susceptibility and three major clones present. The antibiotypes that best defined the ST5-MRSA-IV (Pediatric) clone showed resistance to tobramycin and susceptibility to clindamycin, erythromycin, gentamicin, rifampin, trimethoprim-sulfamethoxazole, vancomycin, quinupristin/dalfopristin, and linezolid, whereas the ST22-MRSA-IV clone (EMRSA-15) showed susceptibility to these antibiotics, and finally, the ST36-MRSA-II clone (EMRSA-16) was resistant to clindamycin, erythromycin, and tobramycin and susceptible to the remaining antimicrobials. Similar observations would allow the early detection of changes in clonal epidemiology by analysis of antimicrobial susceptibility of the isolates within a single institution.
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Affiliation(s)
- Miriam Hernández-Porto
- 1 Servicio de Microbiología y Medicina Preventiva, Hospital Universitario de Canarias , La Laguna, Spain
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17
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Kamberović F, Ibrahimagić A, Uzunović S, Budimir A, Rijnders MIA, Stobberingh EE. mecA-positive methicillin-sensitive Staphylococcus aureus clinical isolates in Zenica-Doboj Canton, Bosnia and Herzegovina. J Chemother 2014; 27:330-6. [PMID: 25112955 DOI: 10.1179/1973947814y.0000000207] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Forty-four mecA-positive and eight mecA-negative Staphylococcus aureus isolates confirmed by PCR were further tested by disc-diffusion (DD) oxacillin and cefoxitin, oxacillin Epsilon (E)-test, and oxacillin and cefoxitin minimal inhibitory concentration (MIC) Strip methicillin-resistant phenotype in S. aureus (MRSA) tests. Among 44 mecA-positive S. aureus isolates, two (4·5%) were detected as MRSA by DD-oxacillin, 17 (38·6%) by DD-cefoxitin test, and seven (15·9%) by the E-test. In the cefoxitin MIC Strip MRSA test, 19 (43·2%) isolates were resistant. In the oxacillin MIC Strip MRSA test, 18 (40·9%) isolates were resistant and 26 (59·1%) were sensitive, i.e. oxacillin-sensitive MRSA (OS-MRSA) (MIC range 0·25-≤0·25 mg/l). Fifteen out of 26 OS-MRSA (57·7%) belonged to spa-CC 355/595, 78% of which belonged to the largest PFGE clone. Some discrepancies between the phenotypic methods for MRSA identification obtained in this study were caused by large proportion of OS-MRSA. Misidentification of OS-MRSA as MSSA might result in an appearance of highly resistant MRSA in patients treated with beta-lactam antibiotics.
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Affiliation(s)
- Farah Kamberović
- University of Ljubljana, Biotechnical Faculty, Microbiology Department , Ljubljana, Slovenia
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18
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Luzzago C, Locatelli C, Franco A, Scaccabarozzi L, Gualdi V, Viganò R, Sironi G, Besozzi M, Castiglioni B, Lanfranchi P, Cremonesi P, Battisti A. Clonal diversity, virulence-associated genes and antimicrobial resistance profile of Staphylococcus aureus isolates from nasal cavities and soft tissue infections in wild ruminants in Italian Alps. Vet Microbiol 2014; 170:157-61. [PMID: 24565474 DOI: 10.1016/j.vetmic.2014.01.016] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2013] [Revised: 01/22/2014] [Accepted: 01/24/2014] [Indexed: 02/05/2023]
Abstract
Staphylococcus aureus is a commensal and a pathogenic bacterium that causes a wide variety of diseases in humans and animals with a high impact on public health and the livestock industry. S. aureus virulence pattern, antimicrobial resistance profile and host specialization are of great concern both in livestock and in companion animals. Concerning wild animals, S. aureus carriage and antimicrobial resistance profile has been recently investigated in free-ranging species both in aquatic and terrestrial environment. Here we report genotyping (spa typing, Multilocus Sequence Typing and SCCmec typing), virulence and antimicrobial resistance profile of four S. aureus isolated in Alpine chamois (Rupicapra r. rupicapra) and roe deer (Capreolus capreolus), euthanized due to walking impairment and signs of disorientation. S. aureus was isolated from nasal cavities in both wild ruminant species and in soft tissue infections in chamois. A marked S. aureus genetic heterogeneity was detected: spa type t1523, sequence type 45 (Clonal Complex 45), and spa type t1328, ST22 (CC22) from the nasal cavities and the liver of a chamois kid respectively, t1773, ST700 (CC130) from an adult chamois abscess, and a new sequence type, ST2712, belonging to CC97 from the roe deer nasal cavities. One of the main findings was the confirmation that the t1328, ST22 isolate, obtained from the liver of the chamois kid, was a methicillin-resistant S. aureus (MRSA) harbouring a SCCmec cassette type IV. The set of virulence marker and toxin genes investigated showed profiles characteristic of the S. aureus lineages detected, including those of the human adapted ST (CC) 22 and ST (CC) 45 isolates.
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Affiliation(s)
- Camilla Luzzago
- Department of Veterinary Science and Public Health, University of Milan, Milan, Italy.
| | - Clara Locatelli
- Department of Health, Animal Science and Food Safety, University of Milan, Milan, Italy
| | - Alessia Franco
- Istituto Zooprofilattico Sperimentale delle Regioni Lazio e Toscana, Rome, Italy
| | - Licia Scaccabarozzi
- Department of Health, Animal Science and Food Safety, University of Milan, Milan, Italy
| | | | | | - Giuseppe Sironi
- Department of Veterinary Science and Public Health, University of Milan, Milan, Italy
| | - Martina Besozzi
- Department of Veterinary Science and Public Health, University of Milan, Milan, Italy
| | | | - Paolo Lanfranchi
- Department of Veterinary Science and Public Health, University of Milan, Milan, Italy
| | - Paola Cremonesi
- Institute of Agricultural Biology and Biotechnology, Milan, Italy
| | - Antonio Battisti
- Istituto Zooprofilattico Sperimentale delle Regioni Lazio e Toscana, Rome, Italy
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19
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Su J, Liu X, Cui H, Li Y, Chen D, Li Y, Yu G. Rapid and simple detection of methicillin-resistance Staphylococcus aureus by orfX loop-mediated isothermal amplification assay. BMC Biotechnol 2014; 14:8. [PMID: 24456841 PMCID: PMC3902190 DOI: 10.1186/1472-6750-14-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Accepted: 01/21/2014] [Indexed: 11/10/2022] Open
Abstract
Background Methicillin-resistant Staphylococcus aureus (MRSA) has become one of the most prevalent pathogens responsible for nosocomial infections throughout the world. As clinical MRSA diagnosis is concerned, current diagnostic methodologies are restricted by significant drawbacks and novel methods are required for MRSA detection. This study aimed at developing a simple loop-mediated isothermal amplification (LAMP) assay targeting on orfX for the rapid detection of methicillin-resistance Staphylococcus aureus (MRSA). Results The protocol was designed by targeting orfX, a highly conserved open reading frame in S. aureus. One hundred and sixteen reference strains, including 52 Gram-positive and 64 Gram-negative isolates, were included for evaluation and optimization of the orfX-LAMP assay. This assay had been further performed on 667 Staphylococcus (566 MRSA, 25 MSSA, 53 MRCNS and 23 MSCNS) strains and were comparatively validated by PCR assay using primers F3 and B3, with rapid template DNA processing, simple equipments (water bath) and direct result determination (both naked eye and under UV light) applied. The indispensability of each primer had been confirmed, and the optimal amplification was obtained under 65°C for 45 min. The 25 μl reactant was found to be the most cost-efficient volume, and the detection limit was determined to be 10 DNA copies and 10 CFU/reaction. High specificity was observed when orfX-LAMP assay was subjected to 116 reference strains. For application, 557 (98.4%, 557/566) and 519 (91.7%, 519/566) tested strains had been detected positive by LAMP and PCR assays. The detection rate, positive predictive value (PPV) and negative predictive value (NPV) of orfX-LAMP were 98.4%, 100% and 92.7% respectively. Conclusions The established orfX-LAMP assay had been demonstrated to be a valid and rapid detection method on MRSA.
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Affiliation(s)
| | | | | | | | - Dingqiang Chen
- Department of Laboratory Medicine, First Affiliated Hospital of Guangzhou Medical College, Guangzhou 510120, China.
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Role of the mecA gene in oxacillin resistance in a Staphylococcus aureus clinical strain with a pvl-positive ST59 genetic background. Antimicrob Agents Chemother 2013; 58:1047-54. [PMID: 24277044 DOI: 10.1128/aac.02045-13] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The most prevalent community-associated methicillin-resistant Staphylococcus aureus (C-MRSA) strains in Taiwan, sequence type 59 (ST59) clones, carry staphylococcal cassette chromosome mec (SCCmec) type V and, to a lesser extent, type IV. These strains show wide variation in sensitivity to oxacillin, but the reasons for this variation are unknown. Here we compared the sequences of the mecA genes from clinical strains of different SCCmec types and found that they contain different mecA promoter mutations. Analysis of mecA promoter activity by reporter gene fusions showed that single base substitutions in the promoter have a strong influence on mecA transcription. The different mecA variants, including promoter sequences, were expressed in the methicillin-sensitive Staphylococcus aureus (MSSA) strain C195 (ST59 background). PBP 2a production among the parental strains and strains with promoter mutant mecA genes showed a close correlation with mecA transcription levels. Furthermore, the quantity of PBP 2a also closely correlated with the level of oxacillin resistance in the C195 background. Our data suggest that mecA promoter mutations play an important role in determining the level of oxacillin resistance. The mecA promoter mutation G-25A (25 bases upstream of the mecA translation start site) was found to be associated with a high oxacillin MIC (256 μg/ml), G-7T conferred a moderate oxacillin MIC (32 to 64 μg/ml), strains with C-33T showed a low oxacillin MIC (4 to 8 μg/ml), and A-38G reversed the effect of the C-33T mutation, restoring the oxacillin resistance level in the A-38G C-33T double mutant. These observations may explain why C-MRSA strains in Taiwan carrying SCCmec type IV or V have such enormous variations in oxacillin MICs.
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Quiblier C, Seidl K, Roschitzki B, Zinkernagel AS, Berger-Bächi B, Senn MM. Secretome analysis defines the major role of SecDF in Staphylococcus aureus virulence. PLoS One 2013; 8:e63513. [PMID: 23658837 PMCID: PMC3643904 DOI: 10.1371/journal.pone.0063513] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2013] [Accepted: 04/02/2013] [Indexed: 01/27/2023] Open
Abstract
The Sec pathway plays a prominent role in protein export and membrane insertion, including the secretion of major bacterial virulence determinants. The accessory Sec constituent SecDF has been proposed to contribute to protein export. Deletion of Staphylococcus aureus secDF has previously been shown to reduce resistance, to alter cell separation, and to change the expression of certain virulence factors. To analyse the impact of the secDF deletion in S. aureus on protein secretion, a quantitative secretome analysis was performed. Numerous Sec signal containing proteins involved in virulence were found to be decreased in the supernatant of the secDF mutant. However, two Sec-dependent hydrolases were increased in comparison to the wild type, suggesting additional indirect, regulatory effects to occur upon deletion of secDF. Adhesion, invasion, and cytotoxicity of the secDF mutant were reduced in human umbilical vein endothelial cells. Virulence was significantly reduced using a Galleria mellonella insect model. Altogether, SecDF is a promising therapeutic target for controlling S. aureus infections.
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Affiliation(s)
- Chantal Quiblier
- Institute of Medical Microbiology, University of Zurich, Zurich, Switzerland
| | - Kati Seidl
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Bernd Roschitzki
- Functional Genomics Center Zurich, Swiss Federal Institute of Technology and University of Zurich, Zurich, Switzerland
| | - Annelies S. Zinkernagel
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | | | - Maria M. Senn
- Institute of Medical Microbiology, University of Zurich, Zurich, Switzerland
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Gowrishankar S, Thenmozhi R, Balaji K, Pandian SK. Emergence of methicillin-resistant, vancomycin-intermediate Staphylococcus aureus among patients associated with group A Streptococcal pharyngitis infection in southern India. INFECTION GENETICS AND EVOLUTION 2013; 14:383-9. [PMID: 23337611 DOI: 10.1016/j.meegid.2013.01.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2012] [Revised: 12/15/2012] [Accepted: 01/03/2013] [Indexed: 11/26/2022]
Abstract
Beyond Staphylococcus aureus being an etiological agent for several serious clinical complications, the foot prints of S. aureus in pharyngitis infection has also been recently recognized. With due response to the fact, a prospective study was conducted between 2009 and 2010 to describe the molecular epidemiology of S. aureus in throat swabs of pharyngitis patients. A total of 63 methicillin-resistant S. aureus (MRSA) and 102 methicillin-susceptible S. aureus (MSSA) isolates were recovered from 265 throat swabs, representing a community-acquired outpatient population from Tamil Nadu, India. Molecular characterization of MRSA was done by two conventional multiplex PCR assays including Panton-Valentine leukocidin (PVL), mecA and nuc genes, and staphylococcal cassette chromosome mec (SCCmec) typing. Among 165 S. aureus isolates, methicillin resistance was observed in 38.2% (n=63), in which 69.8% (n=44/63) of the MRSA along with 55.9% (n=57/102) of MSSA harbored PVL toxin genes. SCCmec typing showed 50.8% of isolates as SCCmec V (n=32), 44.4% as SCCmec III (n=28), and 1.6% as SCCmec types I, II and IVa (n=1). Multilocus sequence typing performed for 26 selected MRSA isolates resulted in 12 different sequence types (ST), including a novel ST2129/SCCmec III, PVL-positive. Ten MRSA isolates were categorized as ST772 (38.5%)/SCCmec V, PVL-positive, and three isolates as ST368 (11.5%)/SCCmec III, PVL-negative. Though the prominent clones of ST772/SCCmec V were multidrug-susceptible worldwide, they were highly multidrug-resistant in the current study, including four clones intermediate to vancomycin. Totally, 10 (15.9%) out of 63 MRSA isolates were documented as vancomycin-intermediate S. aureus (VISA). Collectively, the present study for the first time portrayed the high prevalence of active MRSA pharyngitis infection and also emphasizes an alarming need for discrimination of pharyngeal-asymptomatic carriers of S. aureus from those with an active S. aureus pharyngitis infection.
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Detection of new methicillin-resistant Staphylococcus aureus strains that carry a novel genetic homologue and important virulence determinants. J Clin Microbiol 2012; 50:3374-7. [PMID: 22837322 DOI: 10.1128/jcm.01121-12] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
In this study, 18 methicillin-resistant Staphylococcus aureus (MRSA) isolates harboring staphylococcal cassette chromosome mec (SCCmec) type XI, recovered in the Dutch-German Euregio, were characterized by DNA microarrays. In contrast to previous data, we found two MRSA strains of different clonal lineages possessing SCCmec XI that carried important virulence determinants. The worrisome emergence of such toxigenic MRSA strains raises concerns that MRSA strains with enhanced virulence potential and impaired detectability by standard molecular assays may spread in Europe.
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Colombo C, Senn G, Bürgel A, Ruef C. Clearance of an epidemic clone of methicillin-resistant Staphylococcus aureus in a drug-use network: a follow-up study in Switzerland. ACTA ACUST UNITED AC 2012; 44:650-5. [PMID: 22497490 DOI: 10.3109/00365548.2012.672766] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND A single clone of methicillin-resistant Staphylococcus aureus (MRSA) was observed in a drug-use network starting in 1994, and was found to persist throughout 2001, with up to 19% MRSA colonization of intravenous drug users (IDUs). Recent clinical observations have shown low prevalences of this endemic drug clone among MRSA isolates. The goal of this study was to assess the evolution of MRSA carriage among IDUs. METHODS The survey took place from November 2008 to September 2009. Ten drug dispensary facilities took part. Demographic and clinical data including sex, history of MRSA, past hospitalization, use of antibiotics, and presence of wounds were collected. Screening of the nares, throat, and wounds was done. RESULTS Five hundred and fourteen swab specimens were obtained; 497 of them were nose/throat samples and 17 were wound swabs. MRSA was identified in 5 samples (1%). Four MRSA were found in nose/throat samples and 1 in a wound swab. Pulsed-field gel electrophoresis typing of the MRSA isolates revealed 2 different common endemic types: 4 were identified as the Zurich IDU clone and 1 as the Grison clone. CONCLUSIONS The study shows a significant decline of MRSA colonization among IDUs. The underlying causes for this decline could not be determined fully, but we hypothesize a bundle of interventions as contributing: enhanced medical care, better wound management, isolation management, teaching IDUs basic hygiene techniques, and the national 'Four Pillars' policy. Hospital epidemiological policies such as pre-emptive isolation, length of isolation time, and screening procedures were adapted accordingly.
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Affiliation(s)
- Carlo Colombo
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland.
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25
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mecA-positive Staphylococcus aureus with low-level oxacillin MIC in Taiwan. J Clin Microbiol 2012; 50:1679-83. [PMID: 22378906 DOI: 10.1128/jcm.06711-11] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Although the presence of mecA is the genotypic determinant of methicillin-resistant Staphylococcus aureus (MRSA), certain MRSA strains, especially community-associated MRSA (C-MRSA), can display an oxacillin MIC in the Clinical and Laboratory Standards Institute susceptible breakpoint range (≤ 2 μg/ml). Among 91 and 180 isolates thought to be methicillin-susceptible S. aureus (MSSA) with oxacillin MICs of 2 and 1 μg/ml as determined by the Sensititre broth microdilution test initially, 52 (57.1%) and 6 (3.3%), respectively, were mecA positive. These mecA-positive low-oxacillin-MIC isolates belong to the dominant Taiwan C-MRSA clone (clonal complex [CC] 59), 56 of which carried SCCmec type V and were pvl positive, and 43 of which belonged to spa CC t437. All 271 isolates were retested by Sensititre, as well as by Vitek II and disk diffusion (DD). Based on the oxacillin results, the sensitivities of the Sensititre, Vitek II, and DD methods were 48.3% (28/58), 46.6% (27/58), and 89.6% (52/58), respectively. Although cefoxitin was better at detecting these isolates, 12.1, 10.4, and 5.2% of these isolates were still misidentified as MSSA by Sensititre, Vitek II, and DD, respectively. These results highlight the difficulty in the accurate identification of MRSA with borderline oxacillin MICs in the CC59:SCCmec V clone, which likely has contributed to its spread in the health care and community settings. Since this clone has now been detected in other countries, and since other C-MRSA lineages have also been found to have low-level β-lactam resistance, the findings of the present study may be relevant to other regions. Further studies are warranted to determine the extent and clinical impact of such misidentification.
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Nasal carriage of methicillin-resistant and methicillin-sensitive strains of Staphylococcus sciuri in the Indonesian population. Antimicrob Agents Chemother 2010; 54:5413-7. [PMID: 20837756 DOI: 10.1128/aac.00426-10] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Staphylococcus sciuri strains were unexpectedly cultured from healthy persons and patients from Indonesia during a population-based survey on nasal Staphylococcus aureus carriage. Fifty-one S. sciuri isolates were further characterized. The S. aureus mecA gene was detected by PCR in 22 isolates (43.1%), whereas S. sciuri mecA was found in 33 isolates (64.7%). The staphylococcal cassette chromosome mec (SCCmec) regions of S. aureus mecA-positive isolates contained elements of classical S. aureus SCCmec types II and/or III.
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Yamamoto T, Nishiyama A, Takano T, Yabe S, Higuchi W, Razvina O, Shi D. Community-acquired methicillin-resistant Staphylococcus aureus: community transmission, pathogenesis, and drug resistance. J Infect Chemother 2010; 16:225-54. [PMID: 20336341 PMCID: PMC7088255 DOI: 10.1007/s10156-010-0045-9] [Citation(s) in RCA: 105] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2009] [Indexed: 11/29/2022]
Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) is able to persist not only in hospitals (with a high level of antimicrobial agent use) but also in the community (with a low level of antimicrobial agent use). The former is called hospital-acquired MRSA (HA-MRSA) and the latter community-acquired MRSA (CA-MRSA). It is believed MRSA clones are generated from S. aureus through insertion of the staphylococcal cassette chromosome mec (SCCmec), and outbreaks occur as they spread. Several worldwide and regional clones have been identified, and their epidemiological, clinical, and genetic characteristics have been described. CA-MRSA is likely able to survive in the community because of suitable SCCmec types (type IV or V), a clone-specific colonization/infection nature, toxin profiles (including Pantone-Valentine leucocidin, PVL), and narrow drug resistance patterns. CA-MRSA infections are generally seen in healthy children or young athletes, with unexpected cases of diseases, and also in elderly inpatients, occasionally surprising clinicians used to HA-MRSA infections. CA-MRSA spreads within families and close-contact groups or even through public transport, demonstrating transmission cores. Re-infection (including multifocal infection) frequently occurs, if the cores are not sought out and properly eradicated. Recently, attention has been given to CA-MRSA (USA300), which originated in the US, and is growing as HA-MRSA and also as a worldwide clone. CA-MRSA infection in influenza season has increasingly been noted as well. MRSA is also found in farm and companion animals, and has occasionally transferred to humans. As such, the epidemiological, clinical, and genetic behavior of CA-MRSA, a growing threat, is focused on in this study.
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Affiliation(s)
- Tatsuo Yamamoto
- Division of Bacteriology, Department of Infectious Disease Control and International Medicine, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan.
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Transcriptional profiling of XdrA, a new regulator of spa transcription in Staphylococcus aureus. J Bacteriol 2010; 192:5151-64. [PMID: 20675497 DOI: 10.1128/jb.00491-10] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Transcription of spa, encoding the virulence factor protein A in Staphylococcus aureus, is tightly controlled by a complex regulatory network, ensuring its temporal expression over growth and at appropriate stages of the infection process. Transcriptomic profiling of XdrA, a DNA-binding protein that is conserved in all S. aureus genomes and shares similarity with the XRE family of helix-turn-helix, antitoxin-like proteins, revealed it to be a previously unidentified activator of spa transcription. To assess how XdrA fits into the complex web of spa regulation, a series of regulatory mutants were constructed; consisting of single, double, triple, and quadruple mutants lacking XdrA and/or the three key regulators previously shown to influence spa transcription directly (SarS, SarA, and RNAIII). A series of lacZ reporter gene fusions containing nested deletions of the spa promoter identified regions influenced by XdrA and the other three regulators. XdrA had almost as strong an activating effect on spa as SarS and acted on the same spa operator regions as SarS, or closely overlapping regions. All data from microarrays, Northern and Western blot analyses, and reporter gene fusion experiments indicated that XdrA is a major activator of spa expression that appears to act directly on the spa promoter and not through previously characterized regulators.
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GeneXpert captures unstable methicillin-resistant Staphylococcus aureus prone to rapidly losing the mecA gene. J Clin Microbiol 2010; 48:3030-2. [PMID: 20534797 DOI: 10.1128/jcm.02113-09] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
A cefoxitin-susceptible Staphylococcus aureus strain was identified by the Cepheid GeneXpert as methicillin-resistant S. aureus (MRSA). This strain was highly unstable and rapidly lost SCCmec upon subculturing in vitro, indicating that unstable MRSA is best detected by gene amplification-based methods.
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Nübel U, Dordel J, Kurt K, Strommenger B, Westh H, Shukla SK, Žemličková H, Leblois R, Wirth T, Jombart T, Balloux F, Witte W. A timescale for evolution, population expansion, and spatial spread of an emerging clone of methicillin-resistant Staphylococcus aureus. PLoS Pathog 2010; 6:e1000855. [PMID: 20386717 PMCID: PMC2851736 DOI: 10.1371/journal.ppat.1000855] [Citation(s) in RCA: 140] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2009] [Accepted: 03/11/2010] [Indexed: 11/18/2022] Open
Abstract
Due to the lack of fossil evidence, the timescales of bacterial evolution are largely unknown. The speed with which genetic change accumulates in populations of pathogenic bacteria, however, is a key parameter that is crucial for understanding the emergence of traits such as increased virulence or antibiotic resistance, together with the forces driving pathogen spread. Methicillin-resistant Staphylococcus aureus (MRSA) is a common cause of hospital-acquired infections. We have investigated an MRSA strain (ST225) that is highly prevalent in hospitals in Central Europe. By using mutation discovery at 269 genetic loci (118,804 basepairs) within an international isolate collection, we ascertained extremely low diversity among European ST225 isolates, indicating that a recent population bottleneck had preceded the expansion of this clone. In contrast, US isolates were more divergent, suggesting they represent the ancestral population. While diversity was low, however, our results demonstrate that the short-term evolutionary rate in this natural population of MRSA resulted in the accumulation of measurable DNA sequence variation within two decades, which we could exploit to reconstruct its recent demographic history and the spatiotemporal dynamics of spread. By applying Bayesian coalescent methods on DNA sequences serially sampled through time, we estimated that ST225 had diverged since approximately 1990 (1987 to 1994), and that expansion of the European clade began in 1995 (1991 to 1999), several years before the new clone was recognized. Demographic analysis based on DNA sequence variation indicated a sharp increase of bacterial population size from 2001 to 2004, which is concordant with the reported prevalence of this strain in several European countries. A detailed ancestry-based reconstruction of the spatiotemporal dispersal dynamics suggested a pattern of frequent transmission of the ST225 clone among hospitals within Central Europe. In addition, comparative genomics indicated complex bacteriophage dynamics. Because fossils of bacteria do not exist or are morphologically indeterminate, the timescales of bacterial evolution are widely unknown. We have investigated the short-term evolution of a particular strain of methicillin-resistant Staphylococcus aureus (MRSA), a notorious cause of hospital-associated infections. By comparing 118 kilobases of DNA from MRSA isolates that had been collected at different points in time, we demonstrate that this strain has accumulated measurable DNA sequence variation within two decades. Further, we exploited this sequence diversity to estimate the short-term evolutionary rate and to date divergence times without paleontological calibration, and to reconstruct the recent demographic expansion and spatial spread of this MRSA.
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Affiliation(s)
- Ulrich Nübel
- Robert Koch Institut, Wernigerode, Germany
- * E-mail:
| | | | - Kevin Kurt
- Robert Koch Institut, Wernigerode, Germany
| | | | - Henrik Westh
- Hvidovre Hospital, Hvidovre, Denmark; University of Copenhagen, Faculty of Health, Copenhagen, Denmark
| | - Sanjay K. Shukla
- Marshfield Clinic Research Foundation, Molecular Microbiology Laboratory, Marshfield, Wisconsin, United States of America
| | | | - Raphaël Leblois
- Muséum National d'Histoire Naturelle - Ecole pratique des Hautes Etudes - Centre National de la Recherche Scientifique, Department of Systematics and Evolution, Paris, France
| | - Thierry Wirth
- Muséum National d'Histoire Naturelle - Ecole pratique des Hautes Etudes - Centre National de la Recherche Scientifique, Department of Systematics and Evolution, Paris, France
| | - Thibaut Jombart
- Imperial College Faculty of Medicine, Department of Infectious Disease Epidemiology, Medical Research Council Centre for Outbreak Analysis and Modelling, London, United Kingdom
| | - François Balloux
- Imperial College Faculty of Medicine, Department of Infectious Disease Epidemiology, Medical Research Council Centre for Outbreak Analysis and Modelling, London, United Kingdom
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Otter JA, French GL. Molecular epidemiology of community-associated meticillin-resistant Staphylococcus aureus in Europe. THE LANCET. INFECTIOUS DISEASES 2010; 10:227-39. [DOI: 10.1016/s1473-3099(10)70053-0] [Citation(s) in RCA: 231] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Abstract
Staphylococcus aureus is an important human pathogen and is a growing public health concern. In this study, 130 S. aureus, 93 methicillin-resistant S. aureus (MRSA) and 37 methicillin-sensitive S. aureus (MSSA), clinical isolates recovered from Lebanon were typed by protein A gene (spa) sequencing and multi-locus sequence typing (MLST). Forty-eight different spa types were identified and clustered into 30 different groups. MLST revealed 10 sequence types (STs) among the isolates. There were eight major MRSA clones defined as isolates with the same ST and the same SCCmec type. The majority of the PVL-positive isolates (53%) were ST80-MRSA-IVc. Systematic surveillance of both hospital and community isolates in Lebanon together with measures designed to limit the spread are required.
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Emergence of SCCmec type IV and SCCmec type V methicillin-resistant Staphylococcus aureus containing the Panton-Valentine leukocidin genes in a large academic teaching hospital in central Switzerland: external invaders or persisting circulators? J Clin Microbiol 2009; 48:720-7. [PMID: 20042625 DOI: 10.1128/jcm.01890-09] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The hospital epidemiology of methicillin-resistant Staphylococcus aureus (MRSA) has changed in the past few years due to the encroachment of community-associated MRSA (CA-MRSA) strains into health care settings. MRSA strains that were isolated during a 2-year period from patients of the Luzerner Kantonsspital were analyzed to elucidate their epidemiology. Moreover, extended surveillance of individuals who were contacts of those patients was carried out for 6 months to identify the routes of spread and to assess the quality of the infection control measures used in our setting. Patient data were collected to distinguish CA-MRSA strains from health care-associated MRSA (HA-MRSA) strains by epidemiological criteria, as defined by the Centers for Disease Control and Prevention (CDC). On the basis of the CDC definition, the majority of the strains were considered to be HA-MRSA. However, 87% of them belonged to staphylococcal cassette chromosome mec (SCCmec) types IV and V, which are traditionally associated with CA-MRSA. Surprisingly, classical nosocomial SCCmec types I and II represented a minority, whereas SCCmec type III was completely absent. By PFGE analysis, four predominant clonal lineages and 21 highly variable sporadic genotypes were detected. Twenty-eight percent of the MRSA strains studied carried the genes encoding the Panton-Valentine leukocidin (PVL), of which 21% and 83% were associated with SCCmec types IV and V, respectively. Among 289 contact individuals screened for MRSA carriage throughout the extended surveillance, a single secondary patient was discovered. The possibility of nosocomial transmission could be excluded. The high proportions of SCCmec type IV and V strains as well as PVL-positive strains suggest strong infiltration of CA-MRSA into our institution. Moreover, the low endemic prevalence of MRSA demonstrates that current infection control measures are sufficient to limit its spreading and the emergence of large epidemic outbreaks.
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A rapid, 2-well, multiplex real-time polymerase chain reaction assay for the detection of SCCmec types I to V in methicillin-resistant Staphylococcus aureus. Diagn Microbiol Infect Dis 2009; 65:384-91. [DOI: 10.1016/j.diagmicrobio.2009.08.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2009] [Revised: 06/22/2009] [Accepted: 08/11/2009] [Indexed: 11/23/2022]
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Lozano C, Lopez M, Gomez-Sanz E, Ruiz-Larrea F, Torres C, Zarazaga M. Detection of methicillin-resistant Staphylococcus aureus ST398 in food samples of animal origin in Spain. J Antimicrob Chemother 2009; 64:1325-6. [DOI: 10.1093/jac/dkp378] [Citation(s) in RCA: 92] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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36
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Panton-Valentine leukocidin (PVL)-positive methicillin-susceptible and resistant Staphylococcus aureus in Taiwan: identification of oxacillin-susceptible mecA-positive methicillin-resistant S. aureus. Diagn Microbiol Infect Dis 2009; 65:351-7. [PMID: 19766426 DOI: 10.1016/j.diagmicrobio.2009.07.024] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2009] [Revised: 07/24/2009] [Accepted: 07/30/2009] [Indexed: 11/20/2022]
Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) arises when methicillin-susceptible S. aureus (MSSA) acquires the staphylococcal cassette chromosome mec (SCCmec). Most pvl-positive MRSA in Taiwan belong to ST59 lineage and carry SCCmec V. The genetic profiles of 51 MSSA were compared with those of 80 MRSA from the same hospitals. Nine pvl-positive MSSA (oxacillin MIC < or = 2 microg/mL) shared >80% similarity in pulsed field gel electrophoresis pattern with 17 pvl-positive SCCmec V MRSA. Further investigation found that 5 of these 9 isolates were MRSA by cefoxitin and carried SCCmec V. All 26 pvl-positive isolates had very similar genetic profile (ST59, protein A clonal complex [spa-CC] c2:441/437, and agr group I). The success of the ST59:SCCmec V MRSA may be due in part to its heterogeneous and borderline resistance to methicillin, which may be missed by testing only oxacillin, with subsequent exposure to beta-lactams causing the emergence of more resistant subpopulations.
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37
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Community-associated MRSA – the forthcoming epidemic? Wien Klin Wochenschr 2009; 121:541-3. [DOI: 10.1007/s00508-009-1213-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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38
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Typing of Staphylococcal Cassette Chromosome mec Encoding Methicillin Resistance in Staphylococcus aureus Strains Isolated at the Bone Marrow Transplant Centre of Tunisia. Curr Microbiol 2009; 59:380-5. [DOI: 10.1007/s00284-009-9448-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2009] [Revised: 04/20/2009] [Accepted: 06/18/2009] [Indexed: 11/26/2022]
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In vitro and in vivo properties of dihydrophthalazine antifolates, a novel family of antibacterial drugs. Antimicrob Agents Chemother 2009; 53:3620-7. [PMID: 19546364 DOI: 10.1128/aac.00377-09] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Racemic 2,4-diaminopyrimidine dihydrophthalazine derivatives BAL0030543, BAL0030544, and BAL0030545 exhibited low in vitro MICs toward small, selected panels of Enterococcus faecalis, Enterococcus faecium, Streptococcus pneumoniae, Moraxella catarrhalis, and Mycobacterium avium, though the compounds were less active against Haemophilus influenzae. The constellation of dihydrofolate reductases (DHFRs) present in 20 enterococci and 40 staphylococci was analyzed and correlated with the antibacterial activities of the dihydrophthalazines and trimethoprim. DHFRs encoded by dfrB, dfrA (S1 isozyme), dfrE, and folA were susceptible to the dihydrophthalazines, whereas DHFRs encoded by dfrG (S3 isozyme) and dfrF were not. Studies with the separated enantiomers of BAL0030543, BAL0030544, and BAL0030545 revealed preferential inhibition of susceptible DHFRs by the (R)-enantiomers. BAL0030543, BAL0030544, and BAL0030545 were well tolerated by mice during 5- and 10-day oral toxicity studies at doses of up to 400 mg/kg of body weight. Using a nonoptimized formulation, the dihydrophthalazines displayed acceptable oral bioavailabilities in mice, and efficacy studies with a septicemia model of mice infected with trimethoprim-resistant, methicillin-resistant Staphylococcus aureus gave 50% effective dose values in the range of 1.6 to 6.25 mg/kg.
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Atkinson SR, Paul J, Sloan E, Curtis S, Miller R. The emergence of meticillin-resistant Staphylococcus aureus among injecting drug users. J Infect 2009; 58:339-45. [PMID: 19344954 DOI: 10.1016/j.jinf.2009.03.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2008] [Revised: 02/10/2009] [Accepted: 03/07/2009] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To quantify an observed increase in meticillin-resistant Staphylococcus aureus (MRSA) infections in injecting drug users (IDUs) and, using genetic analysis and clinical presentation, contrast findings with those from previous studies in Brighton to further understanding of the clinical epidemiology and underlying molecular biology associated with the increase. METHODS From 2006 to 2008, isolates of S. aureus were collected, together with clinical details from infected IDUs. Isolates were characterised using antibiotic susceptibilities, multilocus-sequence typing (MLST) and spa typing. The molecular epidemiology and patterns of clinical presentation were compared with results from 1999-2000 to 2000-2003. RESULTS From 2006 to 2008, 18/37 (49%) of clinical isolates from IDUs were MRSA compared with 4/59 (7%) in 2000-2003 and 0/48 (0%) in 1999-2000. Despite this increase, hospital attendances by IDUs for treatment of infection dropped from 3.2 to 1.1 patients per month. MLST showed a shift in population structure towards a single MRSA clone, ST1, rather than epidemic hospital-associated strains. CONCLUSION In IDUs between 2000-2003 and 2006-2008, an increase occurred in the percentage of community-associated S. aureus isolates showing meticillin-resistance, but hospital attendances decreased. IDUs may act as a focus for the emergence of resistant S. aureus strains.
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Affiliation(s)
- S R Atkinson
- Microbiology, Royal Sussex County Hospital, Eastern Road, Brighton BN2 5BE, UK
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41
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Ender M, Berger-Bächi B, McCallum N. A novel DNA-binding protein modulating methicillin resistance in Staphylococcus aureus. BMC Microbiol 2009; 9:15. [PMID: 19173709 PMCID: PMC2658668 DOI: 10.1186/1471-2180-9-15] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2008] [Accepted: 01/27/2009] [Indexed: 11/25/2022] Open
Abstract
Background Methicillin resistance in Staphylococcus aureus is conferred by the mecA-encoded penicillin-binding protein PBP2a. Additional genomic factors are also known to influence resistance levels in strain specific ways, although little is known about their contribution to resistance phenotypes in clinical isolates. Here we searched for novel proteins binding to the mec operator, in an attempt to identify new factor(s) controlling methicillin resistance phenotypes. Results Analysis of proteins binding to a DNA fragment containing the mec operator region identified a novel, putative helix-turn-helix DNA-binding protein, SA1665. Nonpolar deletion of SA1665, in heterogeneously methicillin resistant S. aureus (MRSA) of different genetic backgrounds, increased methicillin resistance levels in a strain dependent manner. This phenotype could be fully complemented by reintroducing SA1665 in trans. Northern and Western blot analyses, however, revealed that SA1665 had no visible influence on mecA transcription or amounts of PBP2a produced. Conclusion SA1665 is a new chromosomal factor which influences methicillin resistance in MRSA. Although SA1665 bound to the mecA promoter region, it had no apparent influence on mecA transcription or translation, suggesting that this predicted DNA-binding protein modulates resistance indirectly, most likely through the control of other genomic factors which contribute to resistance.
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Affiliation(s)
- Miriam Ender
- Institute of Medical Microbiology, University of Zurich, Zurich, Switzerland.
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Ibrahem S, Salmenlinna S, Lyytikäinen O, Vaara M, Vuopio-Varkila J. Molecular characterization of methicillin-resistant Staphylococcus epidermidis strains from bacteraemic patients. Clin Microbiol Infect 2009; 14:1020-7. [PMID: 19040473 DOI: 10.1111/j.1469-0691.2008.02080.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
In order to study the clonality of clinical methicillin-resistant Staphylococcus epidermidis (MRSE) strains and their staphylococcal cassette chromosome mec (SCCmec) elements, 60 isolates of MRSE from bacteraemic patients in three units of the Helsinki University Hospital, Finland were selected, covering the periods 1990-1993 and 1997-1998. The MRSE strains were analysed by pulsed-field gel electrophoresis (PFGE), multilocus sequence typing and SCCmec typing. Eleven PFGE types (FIN-SE-1-11) with sequence type ST2 (clonal complex 2; CC2) were identified. The previously established methicillin-resistant Staphylococcus aureus SCCmec criteria were applied to name the MRSE SCCmec complexes, and it was found that 7% of the isolates carried SCCmec type IA (ccrA1, class B), whereas the majority (93%) yielded six non-typeable SCCmec PCR patterns (P1-P6). Within each SCCmec PCR pattern, two ccr recombinase genes (ccrA2 and ccrA3) and two mec gene complexes (class A and class B) were detected. In addition, the ccrC gene was associated with three of the six patterns. In conclusion, the MRSE strains were genetically related to each other (ST2) but their SCCmec complexes were unique combinations of elements previously recognized among SCCmec types III and IV.
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Affiliation(s)
- S Ibrahem
- Department of Bacterial and Inflammatory Diseases, National Public Health Institute, Helsinki, Finland.
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43
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Deurenberg RH, Stobberingh EE. The evolution of Staphylococcus aureus. INFECTION GENETICS AND EVOLUTION 2008; 8:747-63. [PMID: 18718557 DOI: 10.1016/j.meegid.2008.07.007] [Citation(s) in RCA: 411] [Impact Index Per Article: 25.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2008] [Revised: 07/17/2008] [Accepted: 07/17/2008] [Indexed: 12/29/2022]
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Variability of SCCmec in the Zurich area. Eur J Clin Microbiol Infect Dis 2008; 28:647-53. [DOI: 10.1007/s10096-008-0663-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2008] [Accepted: 10/22/2008] [Indexed: 10/21/2022]
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Strandén AM, Frei R, Adler H, Flückiger U, Widmer AF. Emergence of SCCmec Type IV as the Most Common Type of Methicillin-Resistant Staphylococcus aureus in a University Hospital. Infection 2008; 37:44-8. [DOI: 10.1007/s15010-008-7430-7] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2007] [Accepted: 04/10/2008] [Indexed: 11/25/2022]
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Juhas M, van der Meer JR, Gaillard M, Harding RM, Hood DW, Crook DW. Genomic islands: tools of bacterial horizontal gene transfer and evolution. FEMS Microbiol Rev 2008; 33:376-93. [PMID: 19178566 PMCID: PMC2704930 DOI: 10.1111/j.1574-6976.2008.00136.x] [Citation(s) in RCA: 578] [Impact Index Per Article: 36.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Bacterial genomes evolve through mutations, rearrangements or horizontal gene transfer. Besides the core genes encoding essential metabolic functions, bacterial genomes also harbour a number of accessory genes acquired by horizontal gene transfer that might be beneficial under certain environmental conditions. The horizontal gene transfer contributes to the diversification and adaptation of microorganisms, thus having an impact on the genome plasticity. A significant part of the horizontal gene transfer is or has been facilitated by genomic islands (GEIs). GEIs are discrete DNA segments, some of which are mobile and others which are not, or are no longer mobile, which differ among closely related strains. A number of GEIs are capable of integration into the chromosome of the host, excision, and transfer to a new host by transformation, conjugation or transduction. GEIs play a crucial role in the evolution of a broad spectrum of bacteria as they are involved in the dissemination of variable genes, including antibiotic resistance and virulence genes leading to generation of hospital ‘superbugs’, as well as catabolic genes leading to formation of new metabolic pathways. Depending on the composition of gene modules, the same type of GEIs can promote survival of pathogenic as well as environmental bacteria.
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Affiliation(s)
- Mario Juhas
- Clinical Microbiology and Infectious Diseases, Nuffield Department of Clinical Laboratory Sciences, University of Oxford, Oxford, UK.
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47
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Kilic A, Guclu AU, Senses Z, Bedir O, Aydogan H, Basustaoglu AC. Staphylococcal cassette chromosome mec (SCCmec) characterization and panton-valentine leukocidin gene occurrence for methicillin-resistant Staphylococcus aureus in Turkey, from 2003 to 2006. Antonie van Leeuwenhoek 2008; 94:607-14. [DOI: 10.1007/s10482-008-9278-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2008] [Accepted: 08/18/2008] [Indexed: 10/21/2022]
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48
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Disseminated cutaneous and pulmonary abscesses in an injecting drug user caused by a Panton-Valentine leucocidin-positive, methicillin-susceptible Staphylococcus aureus strain. Eur J Clin Microbiol Infect Dis 2008; 27:1013-5. [DOI: 10.1007/s10096-008-0533-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2007] [Accepted: 04/15/2008] [Indexed: 10/22/2022]
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49
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Community-associated methicillin-resistant Staphylococcus aureus (MRSA) in Australia. Int J Antimicrob Agents 2008; 31:401-10. [DOI: 10.1016/j.ijantimicag.2007.08.011] [Citation(s) in RCA: 98] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2007] [Accepted: 08/10/2007] [Indexed: 11/23/2022]
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50
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Baddour MM, AbuElKheir MM, Fatani AJ. Comparison of mecA polymerase chain reaction with phenotypic methods for the detection of methicillin-resistant Staphylococcus aureus. Curr Microbiol 2007; 55:473-9. [PMID: 17924164 DOI: 10.1007/s00284-007-9015-6] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2006] [Accepted: 06/07/2007] [Indexed: 11/25/2022]
Abstract
In the present study, several conventional methods to detect methicillin-resistant Staphylococcus aureus (MRSA) were compared with polymerase chain reaction (PCR) detection of mecA gene-positive isolates. Cefoxitin E-test was also evaluated as a possible phenotypic method of MRSA detection. Oxacillin agar screen and PBP2' latex agglutination methods were found to be more sensitive than oxacillin and cefoxitin disk-diffusion methods. Cefoxitin disk diffusion was found to be the most specific. A combination of oxacillin agar screening with cefoxitin disk diffusion, or oxacillin disk diffusion with PBP2', improved sensitivity and specificity. Cefoxitin E-test with the current break points had low sensitivity and specificity (33.3% and 75%, respectively) for the detection of MRSA. However, changing the break points to <or= 4 microg/ml and to >or= 6 microg/ml for sensitive and resistant, respectively, greatly improved both. Changing the 30-microg cefoxitin disk-diffusion break points to <or= 21 mm for resistant slightly improved sensitivity but had no effect on specificity. It was therefore concluded that the use of more than one screening method is necessary to detect all MRSA isolates in clinical settings.
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Affiliation(s)
- M M Baddour
- Microbiology and Immunology Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt.
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