Epidemiology, evolution and cryptic susceptibility of methicillin-resistant Staphylococcus aureus in China: a whole-genome-based survey
Epidemiology, evolution and cryptic susceptibility of methicillin-resistant Staphylococcus aureus in China: a whole-genome-based survey
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DOI：
10.1016/j.cmi.2021.05.024
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发表时间：
2021-12-20
影响因子：
14.2
通讯作者：
Yu, Yunsong
中科院分区：
文献类型：
--
作者：
Chen, Yan;Sun, Lu;Yu, Yunsong
目的：本研究的目的是调查中国耐甲氧西林金黄色葡萄球菌（MRSA）的基因组流行病学，以确定优势谱系及其与临床数据和抗菌药物耐药性profiles.Methods的关联：我们进行了一项全国流行病学研究的患者与S。2015年至2017年中国22家三级医院的金黄色葡萄球菌感染。收集每种分离株的患者临床数据和抗菌表型。对一部分分离株进行基因组测序，并进行系统发育分析。结果：1900例S.包括金黄色葡萄球菌感染，其中40%涉及MRSA。社区相关MRSA（CA-MRSA）感染占总分离株的24%。基因组数据显示，超过四分之三的MRSA来自三个优势谱系CC 239（25%，116/471），CC 5（21%，96/471）和CC 59（33%，154/471），其中CC 59占CA-MRSA分离株的一半以上。在53%（251/470）的MRSA中观察到青霉素敏感性基因组特征，包括几乎所有的CC 59（152/154）谱系，96%（242/251）的这些分离株在体外对青霉素或阿莫西林联合克拉维酸敏感。系统发育分析表明，CC 59谱系可以分为6个谱系与所有亚洲CC 59菌株可能产生的祖先中国大陆lineage.Conclusions：这项研究表明，在中国的CA-MRSA的高患病率，主要是由于CC 59的广泛存在。由于该谱系中几乎所有分离株都具有导致β-内酰胺敏感性增加的遗传变异，因此我们建议，为了改善青霉素和β-内酰胺酶抑制剂的抗生素管理组合，应将其纳入抗生素敏感性测试面板中，用于告知治疗决策和对该组合疗法进行的研究。(C)2021年欧洲临床微生物学和传染病学会。由爱思唯尔有限公司出版。保留所有权利。
Objectives: The aim of this study was to investigate the genomic epidemiology of methicillin-resistant Staphylococcus aureus (MRSA) in China to identify predominant lineages and their associations with clinical data and antimicrobial resistance profiles.Methods: We performed a national prevalence study of patients with S. aureus infections in 22 tertiary hospitals in China from 2015 to 2017. Clinical data from patients and the antimicrobial phenotypes were collected for each isolate. Genome sequencing was performed on a proportion of isolates and a phylogenetic analysis was undertaken. Genotypic and phenotypic beta -lactam susceptibilities were compared.Results: A total of 1900 patients with S. aureus infections were included, of which 40% involved MRSA. Community-associated MRSA (CA-MRSA) infections were 24% of the total isolates. Genomic data showed that more than three-quarters of the MRSA were from three dominant lineages CC239 (25%, 116/471), CC5 (21%, 96/471) and CC59 (33%, 154/471) with CC59 accounting for more than half of the CA-MRSA isolates. Penicillin susceptibility genomic features were observed in 53% (251/470) of MRSA, including almost all of the CC59 (152/154) lineage, and 96% (242/251) of these isolates demonstrated in vitro susceptibility to penicillin or amoxicillin combined with clavulanic acid. Phylogenetic analysis indicated that the CC59 lineage can be divided into six lineages with all Asian CC59 isolates likely arising from an ancestral Mainland China lineage.Conclusions: This study showed a high prevalence of CA-MRSA in China, largely due to the widespread presence of CC59. As almost all isolates in this lineage possess genetic variants leading to increased beta-lactam susceptibility, we suggest that to improve antibiotic stewardship combinations of penicillins and beta-lactamase inhibitors should be included in the antibiotic susceptibility testing panels used to inform treatment decisions and research undertaken on this combination therapy. (C) 2021 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.