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Bellis KL, Dissanayake OM, Harrison EM, Aggarwal D. Community methicillin-resistant Staphylococcus aureus outbreaks in areas of low prevalence. Clin Microbiol Infect 2024:S1198-743X(24)00286-6. [PMID: 38897351 DOI: 10.1016/j.cmi.2024.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 05/21/2024] [Accepted: 06/10/2024] [Indexed: 06/21/2024]
Abstract
BACKGROUND Community-acquired (CA), community-onset methicillin-resistant Staphylococcus aureus (CO-MRSA) infection presents a significant public health challenge, even where MRSA rates are historically lower. Despite successes in reducing hospital-onset MRSA, CO-MRSA rates are increasing globally, with a need to understand this trend, and the potential risk factors for re-emergence. OBJECTIVES This review aims to explore the characteristics of outbreaks of community-acquired community-onset methicillin-resistant Staphylococcus aureus in low-prevalence areas, to understand the factors involved in its rise, and to translate this knowledge into public health policy and further research needs. SOURCES PubMed, EMBASE, and Google Scholar were searched using combinations of the terms 'transmission', 'acquisition', 'community-acquired', 'MRSA', 'CA-MRSA', 'low prevalence', 'genomic', 'outbreak', 'colonisation', and 'carriage'. Wherever evidence was limited, additional articles were sought specifically, via PubMed searches. Papers where materials were not available in English were excluded. CONTENT Challenges in defining low-prevalence areas and the significance of exposure to various risk factors for community acquisition, such as healthcare settings, travel, livestock, and environmental factors, are discussed. The importance of genomic surveillance in identifying outbreak strains and understanding the transmission dynamics is highlighted, along with the need for robust public health policies and control measures. IMPLICATIONS The findings emphasise the complexity of CO-MRSA transmission and the necessity of a multifaceted approach in low-prevalence areas. This includes integrated and systematic surveillance of hospital-onset-, CO-, and livestock-associated MRSA, as has been effective in some Northern European countries. The evolution of CO-MRSA underscores the need for global collaboration, routine genomic surveillance, and comprehensive antimicrobial stewardship to mitigate the rise of CO-MRSA and address the broader challenge of antimicrobial resistance. These efforts are crucial for maintaining low MRSA prevalence and managing the increasing burden of CO-MRSA in both low and higher prevalence regions.
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Affiliation(s)
- Katherine L Bellis
- Department of Medicine, University of Cambridge, Hills Rd, Cambridge, UK; Wellcome Sanger Institute, Parasites and Microbes, Hinxton, Saffron Walden, UK
| | - Oshani M Dissanayake
- University College London, Global Business School for Health, Gower St, London, UK
| | - Ewan M Harrison
- Department of Medicine, University of Cambridge, Hills Rd, Cambridge, UK; Wellcome Sanger Institute, Parasites and Microbes, Hinxton, Saffron Walden, UK
| | - Dinesh Aggarwal
- Department of Medicine, University of Cambridge, Hills Rd, Cambridge, UK; Wellcome Sanger Institute, Parasites and Microbes, Hinxton, Saffron Walden, UK; Department of Medicine, Cambridge University Hospital NHS Foundation Trust, Hills Rd, Cambridge, UK.
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Rittscher AE, Vlasblom AA, Duim B, Scherpenisse P, van Schothorst IJ, Wouters IM, Van Gompel L, Smit LAM. A comparison of passive and active dust sampling methods for measuring airborne methicillin-resistant Staphylococcus aureus in pig farms. Ann Work Expo Health 2023; 67:1004-1010. [PMID: 37300560 PMCID: PMC10516621 DOI: 10.1093/annweh/wxad033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 05/24/2023] [Indexed: 06/12/2023] Open
Abstract
Methicillin-resistant strains of Staphylococcus aureus (MRSA) are resistant to most β-lactam antibiotics. Pigs are an important reservoir of livestock-associated MRSA (LA-MRSA), which is genetically distinct from both hospital and community-acquired MRSA. Occupational exposure to pigs on farms can lead to LA-MRSA carriage by workers. There is a growing body of research on MRSA found in the farm environment, the airborne route of transmission, and its implication on human health. This study aims to directly compare two sampling methods used to measure airborne MRSA in the farm environment; passive dust sampling with electrostatic dust fall collectors (EDCs), and active inhalable dust sampling using stationary air pumps with Gesamtstaubprobenahme (GSP) sampling heads containing Teflon filters. Paired dust samples using EDCs and GSP samplers, totaling 87 samples, were taken from 7 Dutch pig farms, in multiple compartments housing pigs of varying ages. Total nucleic acids of both types of dust samples were extracted and targets indicating MRSA (femA, nuc, mecA) and total bacterial count (16S rRNA) were quantified using quantitative real-time PCRs. MRSA could be measured from all GSP samples and in 94% of the EDCs, additionally MRSA was present on every farm sampled. There was a strong positive relationship between the paired MRSA levels found in EDCs and those measured on filters (Normalized by 16S rRNA; Pearson's correlation coefficient r = 0.94, Not Normalized; Pearson's correlation coefficient r = 0.84). This study suggests that EDCs can be used as an affordable and easily standardized method for quantifying airborne MRSA levels in the pig farm setting.
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Affiliation(s)
- Anne E Rittscher
- Institute for Risk Assessment Sciences (IRAS), Faculty of Veterinary Medicine, Utrecht University, Yalelaan 2, 3584 CM Utrecht, The Netherlands
| | - Abel A Vlasblom
- Department of Infectious Diseases and Immunology (I&I), Faculty of Veterinary Medicine, Utrecht University, Yalelaan 1, 3584 CL, Utrecht, The Netherlands
| | - Birgitta Duim
- Department of Infectious Diseases and Immunology (I&I), Faculty of Veterinary Medicine, Utrecht University, Yalelaan 1, 3584 CL, Utrecht, The Netherlands
| | - Peter Scherpenisse
- Institute for Risk Assessment Sciences (IRAS), Faculty of Veterinary Medicine, Utrecht University, Yalelaan 2, 3584 CM Utrecht, The Netherlands
| | - Isabella J van Schothorst
- Institute for Risk Assessment Sciences (IRAS), Faculty of Veterinary Medicine, Utrecht University, Yalelaan 2, 3584 CM Utrecht, The Netherlands
| | - Inge M Wouters
- Institute for Risk Assessment Sciences (IRAS), Faculty of Veterinary Medicine, Utrecht University, Yalelaan 2, 3584 CM Utrecht, The Netherlands
| | - Liese Van Gompel
- Institute for Risk Assessment Sciences (IRAS), Faculty of Veterinary Medicine, Utrecht University, Yalelaan 2, 3584 CM Utrecht, The Netherlands
| | - Lidwien A M Smit
- Institute for Risk Assessment Sciences (IRAS), Faculty of Veterinary Medicine, Utrecht University, Yalelaan 2, 3584 CM Utrecht, The Netherlands
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Fastl C, De Carvalho Ferreira HC, Babo Martins S, Sucena Afonso J, di Bari C, Venkateswaran N, Pires SM, Mughini-Gras L, Huntington B, Rushton J, Pigott D, Devleesschauwer B. Animal sources of antimicrobial-resistant bacterial infections in humans: a systematic review. Epidemiol Infect 2023; 151:e143. [PMID: 37577944 PMCID: PMC10540179 DOI: 10.1017/s0950268823001309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 08/02/2023] [Accepted: 08/05/2023] [Indexed: 08/15/2023] Open
Abstract
Bacterial antimicrobial resistance (AMR) is among the leading global health challenges of the century. Animals and their products are known contributors to the human AMR burden, but the extent of this contribution is not clear. This systematic literature review aimed to identify studies investigating the direct impact of animal sources, defined as livestock, aquaculture, pets, and animal-based food, on human AMR. We searched four scientific databases and identified 31 relevant publications, including 12 risk assessments, 16 source attribution studies, and three other studies. Most studies were published between 2012 and 2022, and most came from Europe and North America, but we also identified five articles from South and South-East Asia. The studies differed in their methodologies, conceptual approaches (bottom-up, top-down, and complex), definitions of the AMR hazard and outcome, the number and type of sources they addressed, and the outcome measures they reported. The most frequently addressed animal source was chicken, followed by cattle and pigs. Most studies investigated bacteria-resistance combinations. Overall, studies on the direct contribution of animal sources of AMR are rare but increasing. More recent publications tailor their methodologies increasingly towards the AMR hazard as a whole, providing grounds for future research to build on.
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Affiliation(s)
- Christina Fastl
- Global Burden of Animal Diseases Programme, University of Liverpool, Liverpool, UK
- Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium
| | | | - Sara Babo Martins
- Global Burden of Animal Diseases Programme, University of Liverpool, Liverpool, UK
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Neston, UK
| | - João Sucena Afonso
- Global Burden of Animal Diseases Programme, University of Liverpool, Liverpool, UK
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Neston, UK
| | - Carlotta di Bari
- Global Burden of Animal Diseases Programme, University of Liverpool, Liverpool, UK
- Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium
- Department of Translational Physiology, Infectiology and Public Health, Ghent University, Merelbeke, Belgium
| | - Narmada Venkateswaran
- Global Burden of Animal Diseases Programme, University of Liverpool, Liverpool, UK
- Institute for Health Metrics and Evaluation, Department of Health Metrics Sciences, University of Washington, Seattle, WA, USA
| | | | - Lapo Mughini-Gras
- Centre for Infectious Disease Control (CIb), National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
- Faculty of Veterinary Medicine, Utrecht University, Institute for Risk Assessment Sciences (IRAS), Utrecht, The Netherlands
| | - Ben Huntington
- Global Burden of Animal Diseases Programme, University of Liverpool, Liverpool, UK
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Neston, UK
- Pengwern Animal Health Ltd, Wallasey, UK
| | - Jonathan Rushton
- Global Burden of Animal Diseases Programme, University of Liverpool, Liverpool, UK
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Neston, UK
| | - David Pigott
- Global Burden of Animal Diseases Programme, University of Liverpool, Liverpool, UK
- Institute for Health Metrics and Evaluation, Department of Health Metrics Sciences, University of Washington, Seattle, WA, USA
| | - Brecht Devleesschauwer
- Global Burden of Animal Diseases Programme, University of Liverpool, Liverpool, UK
- Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium
- Department of Translational Physiology, Infectiology and Public Health, Ghent University, Merelbeke, Belgium
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Zeggay A, Atchon A, Valot B, Hocquet D, Bertrand X, Bouiller K. Genome Analysis of Methicillin-Resistant and Methicillin-Susceptible Staphylococcus aureus ST398 Strains Isolated from Patients with Invasive Infection. Microorganisms 2023; 11:1446. [PMID: 37374948 DOI: 10.3390/microorganisms11061446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 05/25/2023] [Accepted: 05/29/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND Using genomic data, we determined the origin of MRSA ST398 isolates responsible for invasive infection in patients with no known livestock contact. METHODS We sequenced the genome of seven MSSA and four MRSA ST398 isolates from patients with invasive infections between 2013 and 2017, using the Illumina technique. Prophage-associated virulence genes and resistance genes were identified. To determine the origin of the isolates, their genome sequences were included in phylogenetic analysis also encompassing the ST398 genomes available on NCBI. RESULTS All isolates carried the φSa3 prophage, but with variations in the immune evasion cluster: type C in MRSA isolates, and type B in MSSA isolates. All MSSA belonged to the spa type t1451. MRSA strains had the same SCCmec type IVa (2B) cassette and belonged to spa types t899, t4132, t1939 and t2922. All MRSA harbored the tetracycline resistance gene, tet(M). Phylogenetic analysis revealed that MSSA isolates belonged to a cluster of human-associated isolates, while MRSA isolates belonged to a cluster containing livestock-associated MRSA. CONCLUSION We showed that the clinical isolates MRSA and MSSA ST398 have different origins. An acquisition of virulence genes by livestock-associated MRSA isolates allows them to induce an invasive infection in human.
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Affiliation(s)
- Abdeljallil Zeggay
- CHU Besançon, Maladies Infectieuses et Tropicales, 25000 Besançon, France
| | - Alban Atchon
- UMR-CNRS 6249 Chrono-Environnement, Université de Franche-Comté, 25000 Besançon, France
- Bioinformatique et Big Data Au Service de La Santé, UFR Santé, Université de Franche-Comté, 25000 Besançon, France
| | - Benoit Valot
- UMR-CNRS 6249 Chrono-Environnement, Université de Franche-Comté, 25000 Besançon, France
- Bioinformatique et Big Data Au Service de La Santé, UFR Santé, Université de Franche-Comté, 25000 Besançon, France
| | - Didier Hocquet
- UMR-CNRS 6249 Chrono-Environnement, Université de Franche-Comté, 25000 Besançon, France
- Bioinformatique et Big Data Au Service de La Santé, UFR Santé, Université de Franche-Comté, 25000 Besançon, France
- CHU Besançon, Hygiène Hospitalière, 25000 Besançon, France
| | - Xavier Bertrand
- UMR-CNRS 6249 Chrono-Environnement, Université de Franche-Comté, 25000 Besançon, France
- CHU Besançon, Hygiène Hospitalière, 25000 Besançon, France
| | - Kevin Bouiller
- CHU Besançon, Maladies Infectieuses et Tropicales, 25000 Besançon, France
- UMR-CNRS 6249 Chrono-Environnement, Université de Franche-Comté, 25000 Besançon, France
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Konstantinovski MM, Schouls LM, Witteveen S, Claas ECJ, Kraakman ME, Kalpoe J, Mattson E, Hetem DJ, van Elzakker EPM, Kerremans J, Hira V, Bosch T, Gooskens J. Livestock-associated methicillin-resistant Staphylococcus aureus epidemiology, genetic diversity, and clinical characteristics in an urban region. Front Microbiol 2022; 13:875775. [PMID: 36590396 PMCID: PMC9795226 DOI: 10.3389/fmicb.2022.875775] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 11/08/2022] [Indexed: 12/15/2022] Open
Abstract
Objectives While Livestock-associated methicillin-resistant Staphylococcus aureus (LA-MRSA), defined as CC398, is a well-known pathogen among those working with livestock, there are indications that LA-MRSA prevalence among the general population is increasing. However, the clinical impact in urban areas remains unknown. The aim of this study was to assess the genetic epidemiology and clinical characteristics of LA-MRSA in an urban area with a limited livestock population. Methods In this retrospective study, we evaluated LA-MRSA strains that were collected between 2014 and 2018 from patients who received clinical care in a single urban area in Netherlands. Patient files were assessed for livestock exposure data, clinical findings, and contact tracing information. Next-generation sequencing (NGS) analysis in combination with wgMLST was conducted to assess genetic diversity and relatedness and to detect virulence and resistance genes. Results LA-MRSA strains were cultured from 81 patients, comprising 12% of all the MRSA strains found in seven study laboratories between 2014 and 2018. No livestock link was found in 76% of patients (n = 61), and 28% of patients (n = 23) had an infection, mostly of the skin or soft tissue. Contact tracing had been initiated in 14 cases, leading to the identification of two hospital transmissions: a cluster of 9 cases and one of 2 cases. NGS data were available for 91% (n = 75) of the patients. wgMLST confirmed the clusters detected via contact tracing (n = 2) and identified 5 additional clusters without a known epidemiological link. Relevant resistance and virulence findings included the PVL virulence gene (3 isolates) and tetracycline resistance (79 isolates). Conclusion LA-MRSA may cause a relevant burden of disease in urban areas. Surprisingly, most infections in the present study occurred in the absence of a livestock link, suggesting inter-human transmission. These findings and the presence of PVL and other immune evasive complex virulence genes warrant future surveillance and preventative measures.
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Affiliation(s)
- Maria M. Konstantinovski
- Department of Medical Microbiology, Leiden University Medical Center, Leiden, Netherlands,Department of Microbiology, Medical Laboratories, Reinier de Graaf Groep, Delft, Netherlands,*Correspondence: Maria M. Konstantinovski,
| | - Leo M. Schouls
- Center for Infectious Diseases Research, Diagnostics and Laboratory Surveillance, National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands
| | - Sandra Witteveen
- Center for Infectious Diseases Research, Diagnostics and Laboratory Surveillance, National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands
| | - Eric C. J. Claas
- Department of Medical Microbiology, Leiden University Medical Center, Leiden, Netherlands
| | - Margriet E. Kraakman
- Department of Medical Microbiology, Leiden University Medical Center, Leiden, Netherlands
| | - Jayant Kalpoe
- Department of Medical Microbiology, Regional Laboratory of Public Health Kennemerland, Haarlem, Netherlands
| | - Eva Mattson
- Department of Microbiology, Medical Laboratories, Reinier de Graaf Groep, Delft, Netherlands
| | - David J. Hetem
- Department of Medical Microbiology, Haaglanden Medical Center, The Hague, Netherlands
| | | | - Jos Kerremans
- Department of Medical Microbiology, Alrijne Hospital, Leiderdorp, Netherlands
| | - Vishal Hira
- Department of Medical Microbiology and Infection Prevention, Groene Hart Ziekenhuis, Gouda, Netherlands
| | - Thijs Bosch
- Center for Infectious Diseases Research, Diagnostics and Laboratory Surveillance, National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands
| | - Jairo Gooskens
- Department of Medical Microbiology, Leiden University Medical Center, Leiden, Netherlands
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Karampatakis T, Papadopoulos P, Tsergouli K, Angelidis AS, Melidou A, Sergelidis D, Papa A. Genetic characterization of livestock-associated methicillin-resistant Staphylococcus aureus isolated in Greece. Braz J Microbiol 2021; 52:2091-2096. [PMID: 34387854 DOI: 10.1007/s42770-021-00587-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 07/31/2021] [Indexed: 11/26/2022] Open
Abstract
The interest in livestock-associated methicillin-resistant Staphylococcus aureus (LA-MRSA) strains is increasing due to their wide distribution and transmission even in persons without previous contact with livestock, and these strains pose a public health threat. The aim of the study was the genetic characterization of the whole genome of two epidemiologically unrelated t034 LA-MRSA strains previously isolated from the nasal cavities of a goat and a farmer in Greece. Both strains were assigned to the ST398-Vc-t034 type and they were carrying a single transposon identical to Tn6133. They harbored genes conferring resistance to several antibiotics (aminoglycosides, β-lactams, macrolides, streptogramin B, tetracycline, and trimethoprim), and genes associated with virulence (enterotoxins, γ-hemolysins, and aureolysin). The present study can serve as baseline for further LA-MRSA epidemiological and evolutionary studies in Greece, while awareness and increased surveillance are needed to avoid their spread.
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Affiliation(s)
- Theodoros Karampatakis
- Department of Microbiology, Medical School, Aristotle University of Thessaloniki, 541 24, Thessaloniki, Greece.
| | - Panagiotis Papadopoulos
- Laboratory of Food Hygiene-Veterinary Public Health, School of Veterinary Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Katerina Tsergouli
- Department of Microbiology, Medical School, Aristotle University of Thessaloniki, 541 24, Thessaloniki, Greece
| | - Apostolos S Angelidis
- Laboratory of Safety and Quality of Milk and Dairy Products, School of Veterinary Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Angeliki Melidou
- Department of Microbiology, Medical School, Aristotle University of Thessaloniki, 541 24, Thessaloniki, Greece
| | - Daniel Sergelidis
- Laboratory of Food Hygiene-Veterinary Public Health, School of Veterinary Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Anna Papa
- Department of Microbiology, Medical School, Aristotle University of Thessaloniki, 541 24, Thessaloniki, Greece
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7
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Karampatakis T, Papadopoulos P, Tsergouli K, Angelidis AS, Sergelidis D, Papa A. Genetic characterization of two methicillin-resistant Staphylococcus aureus spa type t127 strains isolated from workers in the dairy production chain in Greece. Acta Microbiol Immunol Hung 2021:2021.01460. [PMID: 34133323 DOI: 10.1556/030.2021.01460] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 05/27/2021] [Indexed: 01/22/2023]
Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) constitutes a constant threat for the public health. Aim of the present study was to analyse the whole genome sequences of two MRSA strains belonging to Staphylococcus protein A (spa) type t127 isolated from humans working in two distantly located dairy production farms in Greece.MRSA strains were isolated from the nasal cavity of a food handler in a milk industry in Epirus, northwestern Greece (E-MRSA), and a person working in a cattle farm in Thrace, northeastern Greece (T-MRSA). Whole genome sequences taken using next generation sequencing were analysed for resistance and virulence genes applying various bioinformatic tools.Both isolates were assigned to ST1-IVa-t127 type, and they were transferring genes conferring resistance to tetracycline, β-lactams, and aminoglycosides; T-MRSA was carrying additional genes leading to macrolide, lincosamide and streptogramin B (MLSB) resistance. Both isolates were carrying three plasmid replicon types, rep5, rep7 and rep16, while T-MRSA harboured also rep10 and rep15. E-MRSA carried scn and sak genes which were absent from T-MRSA.In conclusion, the genetic characterization of two unrelated ST1-IVa-t127 MRSA strains isolated from humans in close contact with livestock in Greece can be used as basis for further epidemiological and evolutionary studies.
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Affiliation(s)
- Theodoros Karampatakis
- 1Department of Microbiology, Medical School, Aristotle University of Thessaloniki, Greece
| | - Panagiotis Papadopoulos
- 2Laboratory of Food Hygiene-Veterinary Public Health, School of Veterinary Medicine, Aristotle University of Thessaloniki, Greece
| | - Katerina Tsergouli
- 1Department of Microbiology, Medical School, Aristotle University of Thessaloniki, Greece
| | - Apostolos S Angelidis
- 3Laboratory of Safety and Quality of Milk and Dairy Products, School of Veterinary Medicine, Aristotle University of Thessaloniki, Greece
| | - Daniel Sergelidis
- 2Laboratory of Food Hygiene-Veterinary Public Health, School of Veterinary Medicine, Aristotle University of Thessaloniki, Greece
| | - Anna Papa
- 1Department of Microbiology, Medical School, Aristotle University of Thessaloniki, Greece
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Bouiller K, Bertrand X, Hocquet D, Chirouze C. Human Infection of Methicillin-Susceptible Staphylococcus aureus CC398: A Review. Microorganisms 2020; 8:microorganisms8111737. [PMID: 33167581 PMCID: PMC7694499 DOI: 10.3390/microorganisms8111737] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 11/04/2020] [Accepted: 11/04/2020] [Indexed: 12/25/2022] Open
Abstract
Staphylococcus aureus (SA) belonging to the clonal complex 398 (CC398) took a special place within the species due to its spread throughout the world. SA CC398 is broadly separated in two subpopulations: livestock-associated methicillin-resistant SA (MRSA) and human-associated methicillin-susceptible SA (MSSA). Here, we reviewed the global epidemiology of SA CC398 in human clinical infections and focused on MSSA CC398. The last common ancestor of SA CC398 was probably a human-adapted prophage φSa3-positive MSSA CC398 strain, but the multiple transmissions between human and animal made its evolution complex. MSSA and MRSA CC398 had different geographical evolutions. Although MSSA was present in several countries all over the world, it was mainly reported in China and in France with a prevalence about 20%. MSSA CC398 was frequently implicated in severe infections such as bloodstream infections, endocarditis, and bone joint infections whereas MRSA CC398 was mainly reported in skin and soft tissue. The spread of the MSSA CC398 clone is worldwide but with a heterogeneous prevalence. The prophage φSa3 played a crucial role in the adaptation to the human niche and in the virulence of MSSA CC398. However, the biological features that allowed the recent spread of this lineage are still far from being fully understood.
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Affiliation(s)
- Kevin Bouiller
- Maladies Infectieuses et Tropicales—Centre Hospitalier Universitaire, 25030 Besançon, France;
- UMR-CNRS 6249 Chrono-Environnement, Université Bourgogne Franche-Comté, 25000 Besançon, France; (X.B.); (D.H.)
- Correspondence:
| | - Xavier Bertrand
- UMR-CNRS 6249 Chrono-Environnement, Université Bourgogne Franche-Comté, 25000 Besançon, France; (X.B.); (D.H.)
- Hygiène Hospitalière—Centre Hospitalier Universitaire, 25030 Besançon, France
| | - Didier Hocquet
- UMR-CNRS 6249 Chrono-Environnement, Université Bourgogne Franche-Comté, 25000 Besançon, France; (X.B.); (D.H.)
- Hygiène Hospitalière—Centre Hospitalier Universitaire, 25030 Besançon, France
| | - Catherine Chirouze
- Maladies Infectieuses et Tropicales—Centre Hospitalier Universitaire, 25030 Besançon, France;
- UMR-CNRS 6249 Chrono-Environnement, Université Bourgogne Franche-Comté, 25000 Besançon, France; (X.B.); (D.H.)
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9
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Avberšek J, Golob M, Papić B, Dermota U, Grmek Košnik I, Kušar D, Ocepek M, Zdovc I. Livestock-associated methicillin-resistant Staphylococcus aureus: Establishing links between animals and humans on livestock holdings. Transbound Emerg Dis 2020; 68:789-801. [PMID: 32687685 DOI: 10.1111/tbed.13745] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 07/10/2020] [Accepted: 07/15/2020] [Indexed: 12/01/2022]
Abstract
Livestock-associated methicillin-resistant Staphylococcus aureus (LA-MRSA) represents a concern in both human and veterinary medicine. The aim of this study was to investigate potential LA-MRSA transmission between animals and humans in rural settings. To this aim, a study was designed to include 14 farms in Slovenia, which were selected on the basis of a farmer (initial patient) with confirmed LA-MRSA infection and regular animal contacts. On all farms, the initial patients, their household members, animals and barn environment were analysed for the presence of LA-MRSA. In addition, the epidemiologically linked hospital-related LA-MRSA isolates were included to investigate possible nosocomial transmissions. On five farms, LA-MRSA was discovered both in animals and in humans. In total, 49 LA-MRSA isolates of different origins underwent whole-genome sequencing, antimicrobial susceptibility testing and spa typing. All 49 isolates belonged to the sequence type 398 (ST398), spa types t011 and t034, and harboured staphylococcal chromosomal cassette mec Vc. High levels of concordance between resistance phenotypes and genotypes were observed. No transmission pairs between animals and initial patients were discovered. However, several isolates originating from farm animals and other household members formed clusters with pairwise distances of ≤14 single nucleotide polymorphisms (SNPs), indicating recent transmission events. In addition, three closely related isolates (0 SNP) form hospitalized patients were observed, indicating a possible nosocomial transmission. Two hospital-related isolates harboured the immune evasion cluster genes, which are associated with adaptation to the human host; however, these two isolates differed in >30 SNPs from the remaining isolates. Characteristics of LA-MRSA from Slovenia reflect those observed previously in other European studies. Immune evasion cluster-positive LA-MRSA ST398 suggests its re-adaptation to the human host and calls for a closer monitoring of such emerging LA-MRSA lineages, in addition to monitoring and preventing the introduction of LA-MRSA from farms to hospitals where transmission is highly plausible.
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Affiliation(s)
- Jana Avberšek
- Veterinary Faculty, Institute of Microbiology and Parasitology, University of Ljubljana, Ljubljana, Slovenia
| | - Majda Golob
- Veterinary Faculty, Institute of Microbiology and Parasitology, University of Ljubljana, Ljubljana, Slovenia
| | - Bojan Papić
- Veterinary Faculty, Institute of Microbiology and Parasitology, University of Ljubljana, Ljubljana, Slovenia
| | - Urška Dermota
- National Laboratory of Health, Environment and Food, Kranj, Slovenia
| | | | - Darja Kušar
- Veterinary Faculty, Institute of Microbiology and Parasitology, University of Ljubljana, Ljubljana, Slovenia
| | - Matjaž Ocepek
- Veterinary Faculty, Institute of Microbiology and Parasitology, University of Ljubljana, Ljubljana, Slovenia
| | - Irena Zdovc
- Veterinary Faculty, Institute of Microbiology and Parasitology, University of Ljubljana, Ljubljana, Slovenia
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10
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Sieber RN, Larsen AR, Urth TR, Iversen S, Møller CH, Skov RL, Larsen J, Stegger M. Genome investigations show host adaptation and transmission of LA-MRSA CC398 from pigs into Danish healthcare institutions. Sci Rep 2019; 9:18655. [PMID: 31819134 PMCID: PMC6901509 DOI: 10.1038/s41598-019-55086-x] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 11/19/2019] [Indexed: 02/07/2023] Open
Abstract
Over the last decade, an increasing number of infections with livestock-associated methicillin-resistant Staphylococcus aureus of clonal complex 398 (LA-MRSA CC398) in persons without contact to livestock has been registered in Denmark. These infections have been suggested to be the result of repeated spillover of random isolates from livestock into the community. However, other studies also found emerging sub-lineages spreading among humans. Based on genome-wide SNPs and genome-wide association studies (GWAS), we assessed the population structure and genomic content of Danish LA-MRSA CC398 isolates from healthcare-associated infections from 2014 to 2016 (n = 73) and compared these to isolates from pigs in Denmark from 2014 (n = 183). Phylogenetic analyses showed that most human isolates were closely related to and scattered among pig isolates showing that the majority of healthcare-associated infections are the result of repeated spillover from pig farms, even though cases of human-to-human transmission also were identified. GWAS revealed frequent loss of antimicrobial resistance genes and acquisition of human-specific virulence genes in the human isolates showing adaptation in response to changes in selective pressures in different host environments, which over time could lead to the emergence of LA-MRSA CC398 lineages more adapted to human colonization and transmission.
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Affiliation(s)
- Raphael Niklaus Sieber
- Statens Serum Institut, Department of Bacteria, Parasites & Fungi, Artillerivej 5, 2300, Copenhagen S, Denmark.
| | - Anders Rhod Larsen
- Statens Serum Institut, Department of Bacteria, Parasites & Fungi, Artillerivej 5, 2300, Copenhagen S, Denmark
| | - Tinna Ravnholt Urth
- Statens Serum Institut, Department of Infectious Disease Epidemiology & Prevention, Artillerivej 5, 2300, Copenhagen S, Denmark
| | - Søren Iversen
- Statens Serum Institut, Department of Bacteria, Parasites & Fungi, Artillerivej 5, 2300, Copenhagen S, Denmark
| | - Camilla Holten Møller
- Statens Serum Institut, Department of Infectious Disease Epidemiology & Prevention, Artillerivej 5, 2300, Copenhagen S, Denmark
| | - Robert Leo Skov
- Statens Serum Institut, Department of Bacteria, Parasites & Fungi, Artillerivej 5, 2300, Copenhagen S, Denmark
| | - Jesper Larsen
- Statens Serum Institut, Department of Bacteria, Parasites & Fungi, Artillerivej 5, 2300, Copenhagen S, Denmark
| | - Marc Stegger
- Statens Serum Institut, Department of Bacteria, Parasites & Fungi, Artillerivej 5, 2300, Copenhagen S, Denmark.
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Weterings V, Veenemans J, van Rijen M, Kluytmans J. Prevalence of nasal carriage of methicillin-resistant Staphylococcus aureus in patients at hospital admission in The Netherlands, 2010-2017: an observational study. Clin Microbiol Infect 2019; 25:1428.e1-1428.e5. [PMID: 30928560 DOI: 10.1016/j.cmi.2019.03.012] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 03/14/2019] [Accepted: 03/14/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVES We determined the prevalence of methicillin-resistant Staphylococcus aureus (MRSA) nasal carriage upon hospital admission, among patients who were screened preoperatively for nasal S. aureus carriage between 2010 and 2017. We also aimed to evaluate the prevalence of MRSA carriers without the standard risk factors. METHODS We conducted an observational study to determine the prevalence of MRSA nasal carriage among patients who were screened preoperatively for nasal S. aureus carriage between 2010 and 2017. Samples of cardiothoracic patients were tested by polymerase chain reaction (PCR), other samples were cultured using chromogenic agar plates. A Poisson regression model with robust error variance was used to assess whether there was a trend in the prevalence of MRSA over time. RESULTS In total, 31 093 nasal swabs were obtained from 25 660 patients. Three-hundred and seventy-five swabs (1.2%) had an invalid result. Therefore, 30 718 swabs (98.8%) were included in our analysis. Overall, S. aureus was detected in 7981/30 718 patients (26.0% 95% CI 25.5-26.5%) of whom 41 were MRSA (0.13% 95% CI 0.10-0.18%). The MRSA prevalence varied from 0.03% to 0.17% over the years without evidence of a changing trend over time (p = 0.40). Results of the questionnaire revealed that 30 of the 41 patients (73.2%) had no known risk factors for MRSA carriage (0.10%; 95% CI 0.07-0.14%). CONCLUSION Our study revealed a sustained low prevalence of MRSA carriage upon hospital admission over 7 years. This supports the effectiveness of the Dutch Search and Destroy policy, in combination with a restrictive antibiotic prescription policy.
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Affiliation(s)
- Veronica Weterings
- Department of Infection Control, Amphia Hospital, P.O. Box 90158, 4800 AK Breda, the Netherlands; Medical Microbiology, Radboud University Medical Centre, P.O. Box 9101, 6500 HB Nijmegen, the Netherlands.
| | - Jacobien Veenemans
- Laboratory for Microbiology, Admiraal De Ruyter Hospital, P.O. Box 15, 4460 AA Goes, the Netherlands
| | - Miranda van Rijen
- Department of Infection Control, Amphia Hospital, P.O. Box 90158, 4800 AK Breda, the Netherlands
| | - Jan Kluytmans
- Department of Infection Control, Amphia Hospital, P.O. Box 90158, 4800 AK Breda, the Netherlands; Microvida Laboratory for Microbiology, Amphia Hospital, P.O. Box 90158, Breda, the Netherlands; Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, P.O. Box 85500 3508 GA, Utrecht University, Utrecht, the Netherlands
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12
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Elstrøm P, Grøntvedt CA, Gabrielsen C, Stegger M, Angen Ø, Åmdal S, Enger H, Urdahl AM, Jore S, Steinbakk M, Sunde M. Livestock-Associated MRSA CC1 in Norway; Introduction to Pig Farms, Zoonotic Transmission, and Eradication. Front Microbiol 2019; 10:139. [PMID: 30800102 PMCID: PMC6376739 DOI: 10.3389/fmicb.2019.00139] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 01/21/2019] [Indexed: 01/27/2023] Open
Abstract
Farm animals have been identified as an emerging reservoir for transmission of livestock-associated methicillin-resistant Staphylococcus aureus (LA-MRSA) to humans. The low incidence of MRSA in humans and farm animals in Norway has led to the implementation of a national strategy of surveillance and control of LA-MRSA aiming to prevent livestock becoming a domestic source of MRSA to humans. In 2015, MRSA clonal complex 1 spa-type t177 was identified in nine Norwegian pig herds in two neighboring counties. An outbreak investigation was undertaken, and measures of control through eradication were imposed. We performed a register-based cohort study including pig herds and MRSA-positive persons in Norway between 2008 and 2016 to investigate the livestock-association of MRSA CC1, the transmission of the outbreak strain to humans before and after control measures, and the effect of control measures imposed. Data from the Norwegian Surveillance System of Communicable Diseases were merged with data collected through outbreak investigations for LA-MRSA, the National Registry and the Norwegian Register for Health Personnel. Whole-genome sequencing was performed on isolates from livestock and humans identified through contact tracing, in addition to t177 and t127 isolates diagnosed in persons in the same counties. It is likely that a farm worker introduced MRSA CC1 to a sow farm, and further transmission to eight fattening pig farms through trade of live pigs confirmed the potential for livestock association of this MRSA type. The outbreak strain formed a distinct phylogenetic cluster which in addition to the pig farms included one sheep herd and five exposed persons. None of the investigated isolates from possible cases without direct contact to the MRSA positive farms were phylogenetically related to the outbreak strain. Moreover, isolates of t177 or t127 from healthcare and community-acquired cases were not closely related to the outbreak cluster. Eradication measures imposed were effective in eliminating MRSA t177 from the positive pig holdings, and the outbreak strain was not detected in the national pig population or in persons from these counties after control measures.
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Affiliation(s)
| | | | | | | | | | - Solfrid Åmdal
- The Norwegian Food Safety Authority, Brumunddal, Norway
| | | | | | - Solveig Jore
- The Norwegian Institute of Public Health, Oslo, Norway
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13
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Kinross P, Petersen A, Skov R, Van Hauwermeiren E, Pantosti A, Laurent F, Voss A, Kluytmans J, Struelens MJ, Heuer O, Monnet DL. Livestock-associated meticillin-resistant Staphylococcus aureus (MRSA) among human MRSA isolates, European Union/European Economic Area countries, 2013. ACTA ACUST UNITED AC 2018; 22. [PMID: 29113628 PMCID: PMC5710135 DOI: 10.2807/1560-7917.es.2017.22.44.16-00696] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Currently, surveillance of livestock-associated meticillin-resistant Staphylococcus aureus (LA-MRSA) in humans in Europe is not systematic but mainly event-based. In September 2014, the European Centre for Disease Prevention and Control (ECDC) initiated a questionnaire to collect data on the number of LA-MRSA from human samples (one isolate per patient) from national/regional reference laboratories in European Union/European Economic Area (EU/EEA) countries in 2013. Identification of LA-MRSA as clonal complex (CC) 398 by multilocus sequence typing (MLST) was preferred, although surrogate methods such as spa-typing were also accepted. The questionnaire was returned by 28 laboratories in 27 EU/EEA countries. Overall, LA-MRSA represented 3.9% of 13,756 typed MRSA human isolates, but it represented ≥ 10% in five countries (Belgium, Denmark, Spain, the Netherlands and Slovenia). Seven of the reference laboratories did not type MRSA isolates in 2013. To monitor the dispersion of LA-MRSA and facilitate targeted control measures, we advocate periodic systematic surveys or integrated multi-sectorial surveillance.
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Affiliation(s)
- Pete Kinross
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - Andreas Petersen
- European Programme for Public Health Microbiology (EUPHEM), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden.,Statens Serum Institut, Copenhagen, Denmark
| | | | | | | | - Frédéric Laurent
- International Center for Infectiology Research (CIRI), INSERM, Lyon, France
| | - Andreas Voss
- Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Jan Kluytmans
- University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Marc J Struelens
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - Ole Heuer
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - Dominique L Monnet
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
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- The members of the group are listed at the end of the article
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14
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van Dorp SM, de Greeff SC, Harmanus C, Sanders IMJG, Dekkers OM, Knetsch CW, Kampinga GA, Notermans DW, Kuijper EJ. Ribotype 078 Clostridium difficile infection incidence in Dutch hospitals is not associated with provincial pig farming: Results from a national sentinel surveillance, 2009-2015. PLoS One 2017; 12:e0189183. [PMID: 29287077 PMCID: PMC5747436 DOI: 10.1371/journal.pone.0189183] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Accepted: 11/21/2017] [Indexed: 02/04/2023] Open
Abstract
Background It has been suggested that the high incidence of ribotype 078 Clostridium difficile infections (CDI) in the Netherlands is related to pig farming. Methods We used data of hospitalised CDI patients (>2yrs of age) diagnosed between May 2009 and May 2015 in 26 hospitals participating in a national sentinel surveillance. We compared clinical and geographical characteristics of 078 CDI to other CDI. We investigated the association between 078 CDI incidence and four indicators of pig farming (piglet, pig, piglet farm and pig farm density) by mixed-effects Poisson regression. We used a space-time permutation model to search for community-onset 078 CDI clusters (using SaTScan). Results A total of 4,691 CDI were identified. Ribotype 078 was isolated in 493 of 3,756 patients (13.1%) including a typing result. These patients had slightly higher community-onset disease and a 35% increase of 30-day mortality compared to non-078 CDI patients. The pooled overall and 078 incidence rates were 2.82 (95% CI, 2.42–3.29) and 0.26 (95% CI, 0.21–0.31) CDI per 10,000 patients-days respectively. Hospital 078 CDI incidence was not associated with provincial pig (IRR, 0.98; 95% CI, 0.89–1.08), piglet (IRR, 0.95; 95% CI, 0.75–1.19), pig farm (IRR, 1.08; 95% CI, 0.84–1.39), or piglet farm density (IRR, 1.00; 95% CI, 0.56–1.79). No clusters of community-onset ribotype 078 CDI were found. Conclusions Our results do not indicate that the ribotype 078 CDI incidence in hospitals is related to pig (farm) or piglet (farm) density. However, transmission beyond provincial borders or in non-hospitalised patients cannot be excluded.
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Affiliation(s)
- Sofie M. van Dorp
- Department of Medical Microbiology, Leiden University Medical Center, Leiden, the Netherlands
- * E-mail:
| | - Sabine C. de Greeff
- Centre for Infectious Disease Control, the National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Céline Harmanus
- Department of Medical Microbiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Ingrid M. J. G. Sanders
- Department of Medical Microbiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Olaf M. Dekkers
- Department of Clinical Epidemiology and Endocrinology and Metabolic Diseases, Leiden University Medical Center, Leiden, the Netherlands
| | - Cornelis W. Knetsch
- Department of Medical Microbiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Greetje A. Kampinga
- Department of Medical Microbiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Daan W. Notermans
- Centre for Infectious Disease Control, the National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Ed J. Kuijper
- Department of Medical Microbiology, Leiden University Medical Center, Leiden, the Netherlands
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15
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Bortolami A, Verin R, Chantrey J, Corrò M, Ashpole I, Lopez J, Timofte D. Characterization of Livestock-Associated Methicillin-Resistant Staphylococcus aureus CC398 and mecC-positive CC130 from Zoo Animals in the United Kingdom. Microb Drug Resist 2017; 23:908-914. [PMID: 28783429 PMCID: PMC5665089 DOI: 10.1089/mdr.2017.0161] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Little is known about the characteristics and diseases associated with methicillin-resistant Staphylococcus aureus (MRSA) in nondomestic animals. Four presumptive MRSA isolates, obtained from clinical (n = 3) and surveillance specimens (n = 1) from dwarf (Helogale parvula) and yellow mongooses (Cynictis penicillata) from a United Kingdom zoo, were analyzed by PCR for detection of mecA and mecC-mediated methicillin resistance, and virulence genes. Isolates were genotyped by multilocus sequence typing (MLST) and staphylococcal cassette chromosome mec (SCCmec) and spa sequence typing. Three isolates, obtained from the dwarf mongooses, carried mecA, tetK, and fexA resistance and virulence genes (icaA, icaD, and sec) and were typed to SCCmec IVa, spa type t899, and clonal complex (CC) 398. The fourth MRSA isolate, obtained from the femoral bone marrow of a yellow mongoose showing postmortem findings consistent with septicemia, carried mecC and was oxacillin/cefoxitin susceptible, when tested at 37°C but showed a characteristic MRSA susceptibility profile at 25°C ± 2°C. Furthermore, this isolate exhibited a different genetic background (SCCmecXI/t843/CC130) and had biofilm-associated genes (bap, icaA, and icaD) and tetK tetracycline resistance genes. This work describes the first isolation of livestock-associated MRSA CC398 from two zoo mongoose species where it was associated with both clinical disease and colonization, and the first isolation of mecC MRSA from a zoo species in the United Kingdom. Both reports highlight the potential for zoo species to act as reservoirs for these zoonotic agents.
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Affiliation(s)
- Alessio Bortolami
- Department of Veterinary Pathology, Infection and Public Health, Institute of Veterinary Science, University of Liverpool, Neston, United Kingdom
| | - Ranieri Verin
- Department of Veterinary Pathology, Infection and Public Health, Institute of Veterinary Science, University of Liverpool, Neston, United Kingdom
| | - Julian Chantrey
- Department of Veterinary Pathology, Infection and Public Health, Institute of Veterinary Science, University of Liverpool, Neston, United Kingdom
| | - Michela Corrò
- Istituto Zooprofilattico Sperimentale delle Venezie, Legnaro, Italy
| | | | | | - Dorina Timofte
- Department of Veterinary Pathology, Infection and Public Health, Institute of Veterinary Science, University of Liverpool, Neston, United Kingdom
- Department of Infection Biology, Institute of Infection and Global Health, University of Liverpool, Neston, United Kingdom
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16
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Multi-drug resistant Klebsiella pneumoniae strains circulating in hospital setting: whole-genome sequencing and Bayesian phylogenetic analysis for outbreak investigations. Sci Rep 2017; 7:3534. [PMID: 28615687 PMCID: PMC5471223 DOI: 10.1038/s41598-017-03581-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Accepted: 05/09/2017] [Indexed: 01/12/2023] Open
Abstract
Carbapenems resistant Enterobacteriaceae infections are increasing worldwide representing an emerging public health problem. The application of phylogenetic and phylodynamic analyses to bacterial whole genome sequencing (WGS) data have become essential in the epidemiological surveillance of multi-drug resistant nosocomial pathogens. Between January 2012 and February 2013, twenty-one multi-drug resistant K. pneumoniae strains, were collected from patients hospitalized among different wards of the University Hospital Campus Bio-Medico. Epidemiological contact tracing of patients and Bayesian phylogenetic analysis of bacterial WGS data were used to investigate the evolution and spatial dispersion of K. pneumoniae in support of hospital infection control. The epidemic curve of incident K. pneumoniae cases showed a bimodal distribution of cases with two peaks separated by 46 days between November 2012 and January 2013. The time-scaled phylogeny suggested that K. pneumoniae strains isolated during the study period may have been introduced into the hospital setting as early as 2007. Moreover, the phylogeny showed two different epidemic introductions in 2008 and 2009. Bayesian genomic epidemiology is a powerful tool that promises to improve the surveillance and control of multi-drug resistant pathogens in an effort to develop effective infection prevention in healthcare settings or constant strains reintroduction.
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Earls MR, Kinnevey PM, Brennan GI, Lazaris A, Skally M, O’Connell B, Humphreys H, Shore AC, Coleman DC. The recent emergence in hospitals of multidrug-resistant community-associated sequence type 1 and spa type t127 methicillin-resistant Staphylococcus aureus investigated by whole-genome sequencing: Implications for screening. PLoS One 2017; 12:e0175542. [PMID: 28399151 PMCID: PMC5388477 DOI: 10.1371/journal.pone.0175542] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Accepted: 03/28/2017] [Indexed: 11/19/2022] Open
Abstract
Community-associated spa type t127/t922 methicillin-resistant Staphylococcus aureus (MRSA) prevalence increased from 1%-7% in Ireland between 2010–2015. This study tracked the spread of 89 such isolates from June 2013-June 2016. These included 78 healthcare-associated and 11 community associated-MRSA isolates from a prolonged hospital outbreak (H1) (n = 46), 16 other hospitals (n = 28), four other healthcare facilities (n = 4) and community-associated sources (n = 11). Isolates underwent antimicrobial susceptibility testing, DNA microarray profiling and whole-genome sequencing. Minimum spanning trees were generated following core-genome multilocus sequence typing and pairwise single nucleotide variation (SNV) analysis was performed. All isolates were sequence type 1 MRSA staphylococcal cassette chromosome mec type IV (ST1-MRSA-IV) and 76/89 were multidrug-resistant. Fifty isolates, including 40/46 from H1, were high-level mupirocin-resistant, carrying a conjugative 39 kb iles2-encoding plasmid. Two closely related ST1-MRSA-IV strains (I and II) and multiple sporadic strains were identified. Strain I isolates (57/89), including 43/46 H1 and all high-level mupirocin-resistant isolates, exhibited ≤80 SNVs. Two strain I isolates from separate H1 healthcare workers differed from other H1/strain I isolates by 7–47 and 12–53 SNVs, respectively, indicating healthcare worker involvement in this outbreak. Strain II isolates (19/89), including the remaining H1 isolates, exhibited ≤127 SNVs. For each strain, the pairwise SNVs exhibited by healthcare-associated and community-associated isolates indicated recent transmission of ST1-MRSA-IV within and between multiple hospitals, healthcare facilities and communities in Ireland. Given the interchange between healthcare-associated and community-associated isolates in hospitals, the risk factors that inform screening for MRSA require revision.
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Affiliation(s)
- Megan R. Earls
- Microbiology Research Unit, Dublin Dental University Hospital, University of Dublin, Trinity College, Dublin, Ireland
| | - Peter M. Kinnevey
- Microbiology Research Unit, Dublin Dental University Hospital, University of Dublin, Trinity College, Dublin, Ireland
| | - Gráinne I. Brennan
- Microbiology Research Unit, Dublin Dental University Hospital, University of Dublin, Trinity College, Dublin, Ireland
- National MRSA Reference Laboratory, St. James’s Hospital, Dublin 8, Ireland
| | - Alexandros Lazaris
- Microbiology Research Unit, Dublin Dental University Hospital, University of Dublin, Trinity College, Dublin, Ireland
| | - Mairead Skally
- Department of Microbiology, Beaumont Hospital, Dublin, Ireland
| | - Brian O’Connell
- National MRSA Reference Laboratory, St. James’s Hospital, Dublin 8, Ireland
- Department of Clinical Microbiology, School of Medicine, Trinity College Dublin, St. James’s Hospital, Dublin 8, Ireland
| | - Hilary Humphreys
- Department of Microbiology, Beaumont Hospital, Dublin, Ireland
- Department of Clinical Microbiology, Royal College of Surgeons in Ireland Education and Research Centre, Beaumont Hospital, Dublin, Ireland
| | - Anna C. Shore
- Microbiology Research Unit, Dublin Dental University Hospital, University of Dublin, Trinity College, Dublin, Ireland
| | - David C. Coleman
- Microbiology Research Unit, Dublin Dental University Hospital, University of Dublin, Trinity College, Dublin, Ireland
- * E-mail:
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Hatcher SM, Rhodes SM, Stewart JR, Silbergeld E, Pisanic N, Larsen J, Jiang S, Krosche A, Hall D, Carroll KC, Heaney CD. The Prevalence of Antibiotic-Resistant Staphylococcus aureus Nasal Carriage among Industrial Hog Operation Workers, Community Residents, and Children Living in Their Households: North Carolina, USA. ENVIRONMENTAL HEALTH PERSPECTIVES 2017; 125:560-569. [PMID: 28362266 PMCID: PMC5381988 DOI: 10.1289/ehp35] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Revised: 09/14/2016] [Accepted: 09/14/2016] [Indexed: 05/14/2023]
Abstract
BACKGROUND Antibiotic use in industrial hog operations (IHOs) can support the emergence of antibiotic-resistant (ABR) Staphylococcus aureus. The extent of ABR S. aureus exposure in IHO workers and children living in their households remains unclear. OBJECTIVE We investigated ABR S. aureus nasal carriage prevalence among adults with versus without occupational exposure to IHOs and among children living in their households. METHODS In total, 198 IHO worker-child household pairs and 202 community referent (CR) adult-child household pairs completed a questionnaire and provided a nasal swab which was analyzed for S. aureus, methicillin-resistant S. aureus (MRSA), multidrug-resistant S. aureus (MDRSA), absence of scn (putative marker of livestock association), and spa type. RESULTS S. aureus nasal carriage prevalence was higher among IHO (53%) compared with CR (31%) adults [adjusted prevalence ratio (aPR): 1.40; 95% confidence interval (CI): 1.07, 1.83], but MRSA nasal carriage prevalence was uncommon (2-3%) in IHO and CR adults. MDRSA nasal carriage prevalence was similar among IHO workers and CR adults (12% vs. 8%; aPR: 1.14; 95% CI: 0.56, 2.29). Nasal carriage prevalence was higher among IHO compared with CR children for S. aureus (49% vs. 31%; aPR: 1.50; 95% CI: 1.13, 1.99), MRSA (14% vs. 6%; aPR: 2.37; 95% CI: 1.14, 4.92), and MDRSA (23% vs. 8%; aPR: 2.64; 95% CI: 1.47, 4.75). We also found suggestive evidence of a higher prevalence of S. aureus, MRSA, and MDRSA among children living with an IHO worker who did versus did not report taking personal protective equipment (PPE) home from the IHO. Livestock-associated S. aureus nasal carriage predominated among IHO workers. CONCLUSION Our findings support the importance of further research on the prevalence and potential sources of exposure to ABR S. aureus among children living with IHO workers.
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Affiliation(s)
- Sarah M. Hatcher
- Department of Environmental Sciences and Engineering, UNC Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
| | - Sarah M. Rhodes
- Department of Environmental Sciences and Engineering, UNC Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
| | - Jill R. Stewart
- Department of Environmental Sciences and Engineering, UNC Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
| | - Ellen Silbergeld
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Nora Pisanic
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Jesper Larsen
- Microbiology and Infection Control, Statens Serum Institute, Copenhagen, Denmark
| | - Sharon Jiang
- Department of Environmental Sciences and Engineering, UNC Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
| | - Amanda Krosche
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Devon Hall
- Rural Empowerment Association for Community Help, Warsaw, North Carolina, USA
| | - Karen C. Carroll
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Christopher D. Heaney
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Address correspondence to C.D. Heaney, Departments of Environmental Health and Engineering and Epidemiology, Johns Hopkins Bloomberg School of Public Health, Room W7033B, 615 North Wolfe St., Baltimore, MD 21205 USA. Phone: (443) 287-4989. E-mail:
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19
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Fox A, Pichon B, Wilkinson H, Doumith M, Hill R, McLauchlin J, Kearns A. Detection and molecular characterization of Livestock-Associated MRSA in raw meat on retail sale in North West England. Lett Appl Microbiol 2017; 64:239-245. [DOI: 10.1111/lam.12709] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Revised: 12/23/2016] [Accepted: 12/24/2016] [Indexed: 11/29/2022]
Affiliation(s)
- A. Fox
- Public Health England; Food Water and Environmental Microbiology Services; Preston Laboratory; Preston UK
| | - B. Pichon
- Antimicrobial Resistance and Healthcare Infections Reference Unit; National Infection Service; Public Health England; London UK
| | - H. Wilkinson
- Public Health England; Food Water and Environmental Microbiology Services; Preston Laboratory; Preston UK
| | - M. Doumith
- Antimicrobial Resistance and Healthcare Infections Reference Unit; National Infection Service; Public Health England; London UK
| | - R.L.R. Hill
- Antimicrobial Resistance and Healthcare Infections Reference Unit; National Infection Service; Public Health England; London UK
| | - J. McLauchlin
- Public Health England Food Water and Environmental Microbiology Services; London UK
- Institute of Infection and Global Health; University of Liverpool; Liverpool UK
| | - A.M. Kearns
- Antimicrobial Resistance and Healthcare Infections Reference Unit; National Infection Service; Public Health England; London UK
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