USA300 methicillin-resistant Staphylococcus aureus in Stockholm, Sweden, from 2008 to 2016
USA300 methicillin-resistant Staphylococcus aureus in Stockholm, Sweden, from 2008 to 2016
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DOI：
10.1371/journal.pone.0205761
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发表时间：
2018-11-07
期刊：
影响因子：
3.7
通讯作者：
Fang, Hong
中科院分区：
文献类型：
--
作者：
Enstrom, Josefine;Froding, Inga;Fang, Hong
耐甲氧西林金黄色葡萄球菌 (MRSA) USA300 分离株已在全球范围内得到认可，不仅在社区，而且在医疗机构中也是如此。 USA300 分离株最初仅对甲氧西林具有耐药性，但随着时间的推移，出现了对非 β-内酰胺类药物的耐药性。为了评估斯德哥尔摩 USA300 分离株的流行率和抗菌药物敏感性，我们进行了一项为期九年的回顾性研究。根据脉冲场凝胶电泳图谱，在斯德哥尔摩的 5359 例连续 MRSA 病例中，其中 285 例的分离株为 USA300 菌株。在这些病例中，在六个个体中观察到抗生素耐药性模式改变的重复分离株。因此，对总共291株分离株进行了药敏试验。为了研究分离株在传播事件和基因组抗性性状中的系统发育相关性，通过全基因组测序 (WGS) 进一步研究了 35 个分离株。 MRSA 的发病率从 2008 年的每 10 万居民 17.6 例增加到 2016 年的每 10 万居民 37.3 例，而 USA300 病例的比例从 2008 年的 6.6% 下降到 2016 年的 2.6%。在 USA300 分离株中，73.5% 与社区相关，21.3% 与医疗保健相关， 5.2%的人有未知的获得情况。非β-内酰胺类药物中耐药率最高的是红霉素（86%），其次是氟喹诺酮类药物（68-69%）。 57% 的分离株对红霉素和氟喹诺酮均具有耐药性。在六个分离株中发现同时对四种非β-内酰胺抗生素类别具有耐药性。四种分离株对所有非β-内酰胺抗生素敏感。头孢洛林、达托霉素、利奈唑胺、莫匹罗星、利福平、替考拉宁、特拉万星、甲氧苄啶-磺胺甲恶唑和万古霉素在研究中保留了全部活性。全基因组测序分析表明，爆发的分离株在系统发育上密切相关。总之，斯德哥尔摩的 USA300 MRSA 分离株既不限于社区环境，也不仍然对非 β-内酰胺制剂敏感。 WGS 正在成为追踪传播事件的有用工具。本文的结果提供了有关该地理区域 USA300 菌株状况的最新、最全面的信息。
Methicillin-resistant Staphylococcus aureus (MRSA) USA300 isolates have been recognized globally, not only in community but also in healthcare settings. USA300 isolates were initially resistant only to methicillin, but resistance to non-beta-lactams has emerged with time. To evaluate the prevalence and antimicrobial susceptibility of USA300 isolates in Stockholm, we conducted a nine-year retrospective study. Of 5359 consecutive MRSA cases in Stockholm, isolates from 285 cases were USA300 strains according to the pulsed-field gel electrophoresis pattern. Of these cases, repeated isolates with altered antibiotic resistance patterns were observed in six individuals. Therefore, antimicrobial susceptibility testing was performed on totally 291 isolates. To study the phylogenetic relatedness of isolates in transmission events and genomic resistance traits, 35 isolates were further studied by whole genome sequencing (WGS). The incidence of MRSA was increased from 17.6 per 100,000 inhabitants in 2008 to 37.3 per 100,000 inhabitants in 2016, while the proportion of USA300 cases declined from 6.6% in 2008 to 2.6% in 2016. Among the USA300 isolates, 73.5% were community-associated, 21.3% healthcare-associated, and 5.2% had unknown acquisition. The highest resistance rate among non-beta-lactams was found in erythromycin (86%), followed by fluoroquinolones (68-69%). 57% of the isolates were resistant to both erythromycin and fluoroquinolone. Simultaneous resistance to four non-beta-lactam antibiotic classes was found in six isolates. Four isolates were susceptible to all non-beta-lactam antibiotics. Ceftaroline, daptomycin, linezolid, mupirocin, rifampicin, teicoplanin, telavancin, trimethoprim-sulfamethoxazole and vancomycin retained full activity in the study. WGS analysis indicated that isolates from an outbreak were phylogenetically closely related. In conclusion, USA300 MRSA isolates in Stockholm have neither been limited to the community setting, nor remained susceptible to non-beta-lactam agents. WGS is becoming a useful tool in tracing transmission events. The results herein provide the most up-to-date and comprehensive information regarding status of USA300 strains in this geographic area.