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Svensson S, Hagstedt P, Söderquist B. The MIC distribution of dalbavancin differs between different coagulase-negative staphylococci. JAC Antimicrob Resist 2024; 6:dlae063. [PMID: 38601789 PMCID: PMC11004784 DOI: 10.1093/jacamr/dlae063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Accepted: 03/25/2024] [Indexed: 04/12/2024] Open
Abstract
Background CoNS constitute a significant part of the human microbiota of skin and mucous membranes. They can cause nosocomial infections, and have shown decreased susceptibility to several antibiotics. The few remaining treatment options include (lipo)glycopeptides such as dalbavancin. However, there is a lack of knowledge concerning whether susceptibility to lipoglycopeptides varies between different species of CoNS. Objectives To determine the susceptibility to dalbavancin in different species of CoNS. Methods We investigated 480 bacterial isolates from 10 CoNS species: Staphylococcus epidermidis, Staphylococcus capitis, Staphylococcus caprae, Staphylococcus haemolyticus, Staphylococcus lugdunensis, Staphylococcus warneri, Staphylococcus pettenkoferi, Staphylococcus hominis, Staphylococcus sciuri and Staphylococcus simulans. The isolates were randomly selected from different sources of infection, including blood isolates, as well as deep and superficial infections. Antibiotic susceptibility was tested with the gradient test method. Results There was a statistically significant difference (ANOVA; P < 0.0001) in the MIC distribution for dalbavancin between different CoNS species. S. sciuri was the least susceptible species, with 90% of the isolates having an MIC value for dalbavancin above the EUCAST breakpoint of 0.125 mg/L. The lowest MIC90 values were seen for S. capitis, S. simulans and S. caprae (all 0.032 mg/L). Conclusions This study demonstrated a difference in dalbavancin susceptibility between different CoNS species, suggesting that species-specific breakpoints for CoNS should be further investigated.
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Affiliation(s)
- Sara Svensson
- School of Medical Sciences, Faculty of Medicine and Health, Örebro University, SE-70182 Örebro, Sweden
| | - Paulina Hagstedt
- School of Medical Sciences, Faculty of Medicine and Health, Örebro University, SE-70182 Örebro, Sweden
| | - Bo Söderquist
- School of Medical Sciences, Faculty of Medicine and Health, Örebro University, SE-70182 Örebro, Sweden
- Department of Laboratory Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
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Abdullahi IN, Latorre-Fernández J, Reuben RC, Trabelsi I, González-Azcona C, Arfaoui A, Usman Y, Lozano C, Zarazaga M, Torres C. Beyond the Wild MRSA: Genetic Features and Phylogenomic Review of mecC-Mediated Methicillin Resistance in Non- aureus Staphylococci and Mammaliicocci. Microorganisms 2023; 12:66. [PMID: 38257893 PMCID: PMC10818522 DOI: 10.3390/microorganisms12010066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 12/22/2023] [Accepted: 12/25/2023] [Indexed: 01/24/2024] Open
Abstract
Methicillin resistance, mediated by the mecA gene in staphylococci and mammaliicocci, has caused tremendous setbacks in the use of antibiotics in human and veterinary medicine due to its high potential of presenting the multidrug resistance (MDR) phenotype. Three other mec analogs exist, of which the mecC has evolutionary been associated with methicillin-resistant Staphylococcus aureus (MRSA) in wild animals, thus loosely referred to as the wild MRSA. In this study, we present an epidemiological review and genomic analysis of non-aureus staphylococci and mammaliicocci that carry the mecC-mediated methicillin resistance trait and determine whether this trait has any relevant link with the One Health niches. All previous studies (2007 till 2023) that described the mecC gene in non-aureus staphylococci and mammaliicocci were obtained from bibliometric databases, reviewed, and systematically analyzed to obtain the antimicrobial resistance (AMR) and virulence determinants, mobilome, and other genetic contents. Moreover, core genome single-nucleotide polymorphism analysis was used to assess the relatedness of these strains. Of the 533 articles analyzed, only 16 studies (on livestock, environmental samples, milk bulk tanks, and wild animals) were eligible for inclusion, of which 17 genomes from 6 studies were used for various in silico genetic analyses. Findings from this systematic review show that all mecC-carrying non-aureus staphylococci were resistant to only beta-lactam antibiotics and associated with the classical SCCmec XI of S. aureusLGA251. Similarly, two studies on wild animals reported mecC-carrying Mammaliicoccus stepanovicii associated with SCCmec XI. Nevertheless, most of the mecC-carrying Mammaliicoccus species presented an MDR phenotype (including linezolid) and carried the SCCmec-mecC hybrid associated with mecA. The phylogenetic analysis of the 17 genomes revealed close relatedness (<20 SNPs) and potential transmission of M. sciuri and M. lentus strains in livestock farms in Algeria, Tunisia, and Brazil. Furthermore, closely related M. sciuri strains from Austria, Brazil, and Tunisia (<40 SNPs) were identified. This systematic review enhances our comprehension of the epidemiology and genetic organization of mecC within the non-aureus staphylococci and mammaliicocci. It could be hypothesized that the mecC-carrying non-aureus staphylococci are evolutionarily related to the wild MRSA-mecC. The potential implications of clonal development of a lineage of mecA/mecC carrying strains across multiple dairy farms in a vast geographical region with the dissemination of MDR phenotype is envisaged. It was observed that most mecC-carrying non-aureus staphylococci and mammaliicocci were reported in mastitis cases. Therefore, veterinarians and veterinary microbiology laboratories must remain vigilant regarding the potential existence of mecA/mecC strains originating from mastitis as a potential niche for this resistance trait.
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Affiliation(s)
- Idris Nasir Abdullahi
- Area of Biochemistry and Molecular Biology, OneHealth-UR Research Group, University of La Rioja, 26006 Logroño, Spain; (I.N.A.); (J.L.-F.); (R.C.R.); (C.G.-A.); (C.L.); (M.Z.)
| | - Javier Latorre-Fernández
- Area of Biochemistry and Molecular Biology, OneHealth-UR Research Group, University of La Rioja, 26006 Logroño, Spain; (I.N.A.); (J.L.-F.); (R.C.R.); (C.G.-A.); (C.L.); (M.Z.)
| | - Rine Christopher Reuben
- Area of Biochemistry and Molecular Biology, OneHealth-UR Research Group, University of La Rioja, 26006 Logroño, Spain; (I.N.A.); (J.L.-F.); (R.C.R.); (C.G.-A.); (C.L.); (M.Z.)
| | - Islem Trabelsi
- Bioresources, Environment and Biotechnology Laboratory, Higher Institute of Applied Biological Sciences of Tunis, University of Tunis El Manar, Tunis 1006, Tunisia;
| | - Carmen González-Azcona
- Area of Biochemistry and Molecular Biology, OneHealth-UR Research Group, University of La Rioja, 26006 Logroño, Spain; (I.N.A.); (J.L.-F.); (R.C.R.); (C.G.-A.); (C.L.); (M.Z.)
| | - Ameni Arfaoui
- Laboratory of Microorganisms and Active Biomolecules, Faculty of Sciences of Tunis, University of Tunis El Manar, Tunis 1068, Tunisia;
| | - Yahaya Usman
- Department of Medical Laboratory Science, Ahmadu Bello University, Zaria 810107, Nigeria;
| | - Carmen Lozano
- Area of Biochemistry and Molecular Biology, OneHealth-UR Research Group, University of La Rioja, 26006 Logroño, Spain; (I.N.A.); (J.L.-F.); (R.C.R.); (C.G.-A.); (C.L.); (M.Z.)
| | - Myriam Zarazaga
- Area of Biochemistry and Molecular Biology, OneHealth-UR Research Group, University of La Rioja, 26006 Logroño, Spain; (I.N.A.); (J.L.-F.); (R.C.R.); (C.G.-A.); (C.L.); (M.Z.)
| | - Carmen Torres
- Area of Biochemistry and Molecular Biology, OneHealth-UR Research Group, University of La Rioja, 26006 Logroño, Spain; (I.N.A.); (J.L.-F.); (R.C.R.); (C.G.-A.); (C.L.); (M.Z.)
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Santos ICD, Barbosa LN, Sposito PH, Silva KRD, Caldart ET, Costa LMB, Martins LA, Gonçalves DD. Presence and Resistance Profile of Staphylococcus spp. Isolated from Slaughtered Pigs. Vector Borne Zoonotic Dis 2023; 23:576-582. [PMID: 37695815 DOI: 10.1089/vbz.2022.0074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/13/2023] Open
Abstract
Background: The objective of this study was to isolate Staphylococcus spp. and to characterize the resistance profile in nasal samples from pigs slaughtered for consumption. Material and Methods: Intranasal swabs were collected from 100 pigs immediately after bleeding in a slaughterhouse located in the largest pork production region in Brazil, these samples were cultured and isolated to identify Staphylococcus spp. in coagulase positive (CoPS) and coagulase negative (CoNS) and molecular identification of Staphylococcus aureus and then subjected to the disk-diffusion test to identify the bacterial resistance profile and search for the mecA gene. Results: Of the 100 samples collected, it was possible to isolate 79 Staphylococcus spp., of these, 72.15% were classified as CoNS and 27.85% of the isolates classified as CoPS. Among the CoPS isolates, 77.27% were identified as S. aureus. Through the disk-diffusion test, it was possible to verify isolates resistant to clindamycin and erythromycin (98.73%), chloramphenicol (93.67%), and doxycycline (89.87%). There was amplification of the mecA gene in 30.38% of Staphylococcus spp. Conclusion: The results of this study highlight the need for the careful use of antibiotics in swine production, in addition to aiming at continuous surveillance in relation to the rate of multiresistant microorganisms within these environments, focused on large industrial centers; such results also indicate the importance of understanding, through future studies, possible pathways to transmission of these microorganisms directly, or indirectly, through meat products derived from these pigs, which can be considered neglected diffusers of variants of Staphylococcus spp. resistant to antibiotics or carriers of important resistance genes related to One Health.
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Affiliation(s)
| | | | - Paulo Henrique Sposito
- Médico Veterinário do Ministério da Agricultura, Pecuária e Abastecimento, MAPA/DF, Brasilia, Brasil
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Romanò A, Ivanovic I, Segessemann T, Vazquez Rojo L, Widmer J, Egger L, Dreier M, Sesso L, Vaccani M, Schuler M, Frei D, Frey J, Ahrens CH, Steiner A, Graber HU. Elucidation of the Bovine Intramammary Bacteriome and Resistome from healthy cows of Swiss dairy farms in the Canton Tessin. Front Microbiol 2023; 14:1183018. [PMID: 37583512 PMCID: PMC10425240 DOI: 10.3389/fmicb.2023.1183018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 06/26/2023] [Indexed: 08/17/2023] Open
Abstract
Healthy, untreated cows of nine dairy herds from the Swiss Canton Tessin were analyzed three times within one year to identify the most abundant species of the intramammary bacteriome. Aseptically collected milk samples were cultured and bacteria identified using MALDI-TOF. Of 256 cows analyzed, 96% were bacteriologically positive and 80% of the 1,024 quarters were positive for at least one bacterial species. 84.5% of the quarters were healthy with somatic cell counts (SCC) < 200,000 cells/mL, whereas 15.5% of the quarters showed a subclinical mastitis (SCC ≥ 200,000 cells/mL). We could assign 1,288 isolates to 104 different bacterial species including 23 predominant species. Non-aureus staphylococci and mammaliicocci (NASM) were most prevalent (14 different species; 73.5% quarters). Staphylococcus xylosus and Mammaliicoccus sciuri accounted for 74.7% of all NASM isolates. To describe the intramammary resistome, 350 isolates of the predominant species were selected and subjected to short-read whole genome sequencing (WGS) and phenotypic antibiotic resistance profiling. While complete genomes of eight type strains were available, the remaining 15 were de novo assembled with long reads as a resource for the community. The 23 complete genomes served for reference-based assembly of the Illumina WGS data. Both chromosomes and mobile genetic elements were examined for antibiotic resistance genes (ARGs) using in-house and online software tools. ARGs were then correlated with phenotypic antibiotic resistance data from minimum inhibitory concentration (MIC). Phenotypic and genomic antimicrobial resistance was isolate-specific. Resistance to clindamycin and oxacillin was most frequently observed (65 and 30%) in Staphylococcus xylosus but could not be linked to chromosomal or plasmid-borne ARGs. However, in several cases, the observed antimicrobial resistance could be explained by the presence of mobile genetic elements like tetK carried on small plasmids. This represents a possible mechanism of transfer between non-pathogenic bacteria and pathogens of the mammary gland within and between herds. The-to our knowledge-most extensive bacteriome reported and the first attempt to link it with the resistome promise to profoundly affect veterinary bacteriology in the future and are highly relevant in a One Health context, in particular for mastitis, the treatment of which still heavily relies on antibiotics.
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Affiliation(s)
- Alicia Romanò
- Food Microbial Systems, Group Microbiological Safety of Foods of Animal Origin, Agroscope, Bern, Switzerland
- Graduate School of Cellular and Biomedical Sciences, University of Bern, Bern, Switzerland
| | - Ivana Ivanovic
- Food Microbial Systems, Group Microbiological Safety of Foods of Animal Origin, Agroscope, Bern, Switzerland
| | - Tina Segessemann
- SIB, Swiss Institute of Bioinformatics, Zürich, Switzerland
- Method Development and Analytics, Group Molecular Ecology, Agroscope, Zürich, Switzerland
| | - Laura Vazquez Rojo
- Food Microbial Systems, Group Microbiological Safety of Foods of Animal Origin, Agroscope, Bern, Switzerland
| | - Jérôme Widmer
- Method Development and Analytics, Group Biochemistry of Milk, Agroscope, Bern, Switzerland
| | - Lotti Egger
- Method Development and Analytics, Group Biochemistry of Milk, Agroscope, Bern, Switzerland
| | - Matthias Dreier
- Food Microbial Systems, Group Cultures, Biodiversity, and Terroir, Agroscope, Bern, Switzerland
| | - Lorenzo Sesso
- Clinic of Ruminants, Vetsuisse Faculty, University of Bern, Bern, Switzerland
| | - Michael Vaccani
- Clinic of Ruminants, Vetsuisse Faculty, University of Bern, Bern, Switzerland
| | - Martin Schuler
- SIB, Swiss Institute of Bioinformatics, Zürich, Switzerland
- Method Development and Analytics, Group Molecular Ecology, Agroscope, Zürich, Switzerland
| | - Daniel Frei
- Method Development and Analytics, Group Molecular Diagnostics, Genomics, and Bioinformatics, Agroscope, Wädenswil, Switzerland
| | - Juerg Frey
- Method Development and Analytics, Group Molecular Diagnostics, Genomics, and Bioinformatics, Agroscope, Wädenswil, Switzerland
| | - Christian H. Ahrens
- SIB, Swiss Institute of Bioinformatics, Zürich, Switzerland
- Method Development and Analytics, Group Molecular Ecology, Agroscope, Zürich, Switzerland
| | - Adrian Steiner
- Clinic of Ruminants, Vetsuisse Faculty, University of Bern, Bern, Switzerland
| | - Hans Ulrich Graber
- Food Microbial Systems, Group Microbiological Safety of Foods of Animal Origin, Agroscope, Bern, Switzerland
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Tchamba CN, Touzain F, Fergestad M, De Visscher A, L'Abee-Lund T, De Vliegher S, Wasteson Y, Blanchard Y, Argudín MA, Mainil J, Thiry D. Identification of staphylococcal cassette chromosome mec in Staphylococcus aureus and non-aureus staphylococci from dairy cattle in Belgium: Comparison of multiplex PCR and whole genome sequencing. Res Vet Sci 2023; 155:150-155. [PMID: 36696786 DOI: 10.1016/j.rvsc.2023.01.011] [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: 05/16/2022] [Revised: 12/06/2022] [Accepted: 01/14/2023] [Indexed: 01/19/2023]
Abstract
The present study compared multiplex PCR (mPCR) and Whole Genome Sequencing (WGS) using the SCCmecFinder database to identify the Staphylococcal Cassette Chromosome (SCC) mec in five Staphylococcus aureus (SA) and nine non-aureus staphylococci (NAS) isolated from dairy cattle. mPCR identified an SCCmecIV in four SA and one NAS, but could not differentiate between SCCmecII and IV in the fifth SA, that all harbored the mecA gene and were phenotypically resistant to cefoxitin. SCCmecFinder confirmed the presence of an SCCmecIVc(2B) in four SA and of the SCCmecIVa(2B) in the fifth SA and the one NAS. Both methods also detected one untypeable SCCmec in another cefoxitin-resistant NAS harboring the mecA gene and a pseudo SCCmec in one cefoxitin-sensitive NAS harboring one mecC-related gene. No SCCmec elements were identified either in one cefoxitin-sensitive NAS harboring the mecA2 gene, or in five NAS (one resistant and four sensitive to cefoxitin) harboring the mecA1 gene. SCCmecFinder could even not identify the presence of any mecA1 gene in these five NAS, whose presence was nevertheless confirmed by ResFinder. The conclusions of this study are: (i) mPCR and WGS sequencing using SCCmecFinder are complementary methodologies to identify SCCmec; (ii) SCCmecFinder and ResFinder to a lesser extent cannot identify all mec gene allotypes; (iii) a specific classification of the SCCmec in NAS would be epidemiologically helpful; (iv) presence of a mecA gene and a complete SCCmec is linked to cefoxitin resistance, whereas presence of other mec genes and of pseudo or no SCCmec is not.
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Affiliation(s)
- Cyrille Ngassam Tchamba
- Bacteriology, Department of Infectious and Parasitic Diseases, Faculty of Veterinary Medicine and Institute for Fundamental and Applied Research in Animals and Health (FARAH), University of Liège Liège, Belgium
| | - Fabrice Touzain
- Viral Genetics and Bio-security Unit, ANSES, Ploufragan-Plouzané-Niort laboratory, Ploufragan, France
| | - Marte Fergestad
- Department of Paraclinical Sciences, Faculty of Veterinary Medicine, Norwegian University of Life Sciences, Ås, Norway
| | - Anneleen De Visscher
- M-team & Mastitis and Milk Quality Research Unit, Department of Reproduction, Obstetrics and Herd Health, Faculty of Veterinary Medicine, University of Ghent, Merelbeke, Belgium
| | - Trine L'Abee-Lund
- Department of Paraclinical Sciences, Faculty of Veterinary Medicine, Norwegian University of Life Sciences, Ås, Norway
| | - Sarne De Vliegher
- M-team & Mastitis and Milk Quality Research Unit, Department of Reproduction, Obstetrics and Herd Health, Faculty of Veterinary Medicine, University of Ghent, Merelbeke, Belgium
| | - Yngvild Wasteson
- Department of Paraclinical Sciences, Faculty of Veterinary Medicine, Norwegian University of Life Sciences, Ås, Norway
| | - Yannick Blanchard
- Viral Genetics and Bio-security Unit, ANSES, Ploufragan-Plouzané-Niort laboratory, Ploufragan, France
| | - Maria A Argudín
- Molecular Biology, Cliniques universitaires Saint Luc, Catholic University of Louvain, Brussels, Belgium
| | - Jacques Mainil
- Bacteriology, Department of Infectious and Parasitic Diseases, Faculty of Veterinary Medicine and Institute for Fundamental and Applied Research in Animals and Health (FARAH), University of Liège Liège, Belgium
| | - Damien Thiry
- Bacteriology, Department of Infectious and Parasitic Diseases, Faculty of Veterinary Medicine and Institute for Fundamental and Applied Research in Animals and Health (FARAH), University of Liège Liège, Belgium.
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6
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Angeli A, Urbański LJ, Capasso C, Parkkila S, Supuran CT. Activation studies with amino acids and amines of a β-carbonic anhydrase from Mammaliicoccus (Staphylococcus) sciuri previously annotated as Staphylococcus aureus (SauBCA) carbonic anhydrase. J Enzyme Inhib Med Chem 2022; 37:2786-2792. [PMID: 36210544 PMCID: PMC9553136 DOI: 10.1080/14756366.2022.2131780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
A β-carbonic anhydrase (CA, EC 4.2.1.1) previously annotated to be present in the genome of Staphylococcus aureus, SauBCA, has been shown to belong to another pathogenic bacterium, Mammaliicoccus (Staphylococcus) sciuri. This enzyme, MscCA, has been investigated for its activation with a series of natural and synthetic amino acid and amines, comparing the results with those obtained for the ortholog enzyme from Escherichia coli, EcoCAβ. The best MscCA activators were D-His, L- and D-DOPA, 4-(2-aminoethyl)-morpholine and L-Asn, which showed KAs of 0.12 - 0.89 µM. The least efficient activators were D-Tyr and L-Gln (KAs of 13.9 - 28.6 µM). The enzyme was also also inhibited by anions and sulphonamides, as described earlier. Endogenous CA activators may play a role in bacterial virulence and colonisation of the host which makes this research topic of great interest.
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Affiliation(s)
- Andrea Angeli
- Dipartimento Neurofarba, Sezione di Scienze Farmaceutiche e Nutraceutiche, Università degli Studi di Firenze, Sesto Fiorentino (Florence), Italy
| | - Linda J Urbański
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Clemente Capasso
- Department of Biology, Agriculture and Food Sciences, Institute of Biosciences and Bioresources, Napoli, Italy
| | - Seppo Parkkila
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland,Fimlab Ltd, Tampere University Hospital, Tampere, Finland,CONTACT Seppo Parkkila Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland; Fimlab Ltd, Tampere University Hospital, Tampere, Finland
| | - Claudiu T. Supuran
- Dipartimento Neurofarba, Sezione di Scienze Farmaceutiche e Nutraceutiche, Università degli Studi di Firenze, Sesto Fiorentino (Florence), Italy,Claudiu T. Supuran Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
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7
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Molecular Mechanisms of Drug Resistance in Staphylococcus aureus. Int J Mol Sci 2022; 23:ijms23158088. [PMID: 35897667 PMCID: PMC9332259 DOI: 10.3390/ijms23158088] [Citation(s) in RCA: 70] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 07/18/2022] [Accepted: 07/20/2022] [Indexed: 12/03/2022] Open
Abstract
This paper discusses the mechanisms of S. aureus drug resistance including: (1) introduction. (2) resistance to beta-lactam antibiotics, with particular emphasis on the mec genes found in the Staphylococcaceae family, the structure and occurrence of SCCmec cassettes, as well as differences in the presence of some virulence genes and its expression in major epidemiological types and clones of HA-MRSA, CA-MRSA, and LA-MRSA strains. Other mechanisms of resistance to beta-lactam antibiotics will also be discussed, such as mutations in the gdpP gene, BORSA or MODSA phenotypes, as well as resistance to ceftobiprole and ceftaroline. (3) Resistance to glycopeptides (VRSA, VISA, hVISA strains, vancomycin tolerance). (4) Resistance to oxazolidinones (mutational and enzymatic resistance to linezolid). (5) Resistance to MLS-B (macrolides, lincosamides, ketolides, and streptogramin B). (6) Aminoglycosides and spectinomicin, including resistance genes, their regulation and localization (plasmids, transposons, class I integrons, SCCmec), and types and spectrum of enzymes that inactivate aminoglycosides. (7). Fluoroquinolones (8) Tetracyclines, including the mechanisms of active protection of the drug target site and active efflux of the drug from the bacterial cell. (9) Mupirocin. (10) Fusidic acid. (11) Daptomycin. (12) Resistance to other antibiotics and chemioterapeutics (e.g., streptogramins A, quinupristin/dalfopristin, chloramphenicol, rifampicin, fosfomycin, trimethoprim) (13) Molecular epidemiology of MRSA.
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