For Personal Use. Only Reproduce with Permission from the Lancet Publishing Group. Molecular Evolution of Mrsa Secrets of Success of a Human Pathogen: Molecular Evolution of Pandemic Clones of Meticillin- Resistant Staphylococcus Aureus
For Personal Use. Only Reproduce with Permission from the Lancet Publishing Group. Molecular Evolution of Mrsa Secrets of Success of a Human Pathogen: Molecular Evolution of Pandemic Clones of Meticillin- Resistant Staphylococcus Aureus
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D. Oliveira;A. Tomasz;H. de Lencastre
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作者：
D. Oliveira;A. Tomasz;H. de Lencastre
1960年在欧洲发现了第一株耐甲氧西林金黄色葡萄球菌（MRSA）。从那时起，MRSA已成为全球医院感染的主要原因。使用分子分型技术，主要是脉冲场凝胶电泳（PFGE），我们确定了五个主要的MRSA克隆，占近70%的3000多个MRSA分离株，主要是在南欧和东欧，南美和美国的医院回收。我们的大部分监测研究都是在这些地区进行的。该集合的代表性分离株的多位点测序分型（MLST）表明，这五个大流行性MRSA克隆仅从两个不同的祖先遗传背景演变而来，其中一个可以追溯到最早的欧洲MRSA分离株，也可以追溯到20世纪50年代中后期在丹麦医院流通的甲氧西林敏感金黄色葡萄球菌菌株，即在将甲氧西林引入治疗之前不久。具有完全不同MLST特征的第二个谱系包括在美国、日本和世界多个地区的儿科分离株中经常回收的MRSA。在早期丹麦分离株中还检测到一些具有与EMRSA-16对应的第三种不同MLST类型的分离株。四种结构类型的mec元件，异源DNA片段含有甲氧西林耐药决定簇mecA，存在于独特的组合与MRSA克隆类型。我们的研究结果建立了最广泛传播的MRSA大流行克隆的进化关联。导致一些MRSA克隆大规模传播的流行病学因素尚未得到很好的理解。然而，我们认为MRSA有效性的秘密可能隐藏在令人惊讶的少数金黄色葡萄球菌谱系的独特遗传背景中，这些谱系特别能够科普当代临床环境。金黄色葡萄球菌的适应能力：耐药性菌株的出现金黄色葡萄球菌长期以来被认为是导致从皮肤轻微感染到伤口感染、菌血症、中枢神经系统、呼吸道和泌尿道感染以及与血管内器械和异物相关的感染的广泛疾病的主要人类病原体之一。大多数金黄色葡萄球菌菌株是机会致病菌，可以在没有症状的情况下在短期或长期内定植于个体，当免疫系统受损时引起疾病。有迹象表明，这种细菌病原体自史前时代以来一直影响着人类。在抗生素时代之前，金黄色葡萄球菌疾病的死亡率很高。1941年，死亡率...
The first European isolate of meticillin-resistant Staphylococcus aureus (MRSA) was detected in 1960. Since then MRSA has become a leading cause of nosocomial infections worldwide. Using molecular typing techniques—primarily pulsed-field gel electrophoresis (PFGE)—we identified five major MRSA clones that accounted for almost 70% of the over 3000 MRSA isolates recovered in hospitals mainly in southern and eastern Europe, South America, and the USA. Most of our surveillance studies were done in these areas. Multilocus sequencing typing (MLST) of representative isolates of this collection showed that these five pandemic MRSA clones have evolved from only two distinct ancestral genetic backgrounds, one of which can be traced back to the very first European MRSA isolates and also to meticillin susceptible S aureus strains circulating in Danish hospitals during the mid to late 1950s—ie, shortly before the introduction of meticillin into therapy. The second lineage with a completely different MLST profile included MRSA frequently recovered in the USA, Japan, and among paediatric isolates from several parts of the world. A few isolates with a third distinct MLST type corresponding to that of EMRSA-16 were also detected in the early Danish isolates. The four structural types of mec element, the heterologous DNA segment containing the meticillin resistance determinant mecA, were present in unique combinations with the MRSA clonal types. Our findings establish evolutionary associations in the most widely spread pandemic clones of MRSA. The epidemiological factors that contributed to the massive dissemination of a few MRSA clones are not well understood. We suggest, however, that the secrets of effectiveness of MRSA could be hidden in the unique genetic background of a surprisingly few lineages of S aureus particularly well able to cope with the contemporary clinical environment. The adaptive power of Staphylococcus aureus: emergence of antibiotic-resistant strains Staphylococcus aureus has long been recognised as one of the major human pathogens responsible for a wide range of afflictions from minor infections of the skin to wound infections, bacteraemia, infections of the central nervous system, respiratory and urinary tracts, and infections associated with intravascular devices and foreign bodies. Most S aureus strains are opportunistic pathogens that can colonise individuals, without symptoms, for either short or extended periods of time, causing disease when the immune system becomes compromised. Indications are that this bacterial pathogen has affected human beings since prehistoric times. Before the antibiotic era S aureus diseases had high mortality rates. In 1941 the mortality rate …