New patterns of methicillin-resistant Staphylococcus aureus (MRSA) clones, community-associated MRSA genotypes behave like healthcare-associated MRSA genotypes within hospitals, Argentina
New patterns of methicillin-resistant Staphylococcus aureus (MRSA) clones, community-associated MRSA genotypes behave like healthcare-associated MRSA genotypes within hospitals, Argentina
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DOI：
10.1016/j.ijmm.2014.08.002
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发表时间：
2014-11-01
影响因子：
4.1
通讯作者：
Sola, Claudia
中科院分区：
文献类型：
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作者：
Egea, Ana L.;Gagetti, Paula;Sola, Claudia
耐甲氧西林金黄色葡萄球菌(MRSA)在世界范围内的医院[医疗保健相关(HA)-MRSA]和社区[社区相关(CA)-MRSA]的负担正在增加。然而，CA-MRSA在医院内的影响仍然有限，特别是在拉丁美洲。在阿根廷进行了一项具有全国代表性的金黄色葡萄球菌感染调查，分析了66家医院的591个临床分离株，进行了一项前瞻性的横断面多中心研究(2009年11月)。这项研究涉及医疗性感染(HAHO，>；48个住院小时)和社区起病(CO)感染[包括两者，有医疗保健相关风险因素(HRFs)的患者的感染(Haco)和没有HRFs的患者的感染(CACO)]。用SCCmec-SPA分型、PFGE、MLST基因分型和毒力基因图谱分析，将MRSA菌株分为CA-MRSA(G)和HA-MRSA(G)两种基因型。考虑到所有分离株，63%来自混合感染，55%为MRSA[39%CA-MRSA(G)和16%HA-MRSAG]。CO-S的MRSA比例显著高于HAHO-S。检测到金黄色葡萄球菌感染(58%对49%)；主要发生在儿童(62%对43%)。CA-MRSA(G)/HA-MRSA(G)占HAHO-感染的16%/33%，HACO-感染的39%/13%，CACO感染的60.5%/0%。关于在多变量模型中确定的医疗性CA-MRSA(G)感染患者的流行病学关系，CA-MRSA(G)在医院内的表现与HA-MRSAG相似，但儿童是医疗性CA-MRSAG感染的最高风险群体。大多数CA-MRSAG属于两个主要克隆：PFGE型N-ST30-SCCmecIVc-t019-PVL+和PFGE-I-ST5-IV-SCCmecIVa-t311-PVL+(各占45%)。ST5-IV-PVL+/ST30-IV-PVL+克隆引起的感染占总感染的31%/33%，HAHO-感染的20%/4%，HACO-感染的43%/23%，CACO感染的35%/60%，不同年龄组(儿童/成人)和地理区域的差异显著。重要的是，在阿根廷首次检测到属于USA300-0114-(ST8-SCCmecIVa-spat008-PVL+-ACME(+))的分离物。大多数HA-MRSAG(66%)与Cordobes/智利克隆(PFGE-type A-st5-SCCmecl-t149)有关，导致18%的感染(47%的HAHO-和13%的HACO感染)。
Methicillin-resistant Staphylococcus aureus (MRSA) burden is increasing worldwide in hospitals [healthcare-associated (HA)-MRSA] and in communities [community-associated (CA)-MRSA]. However, the impact of CA-MRSA within hospitals remains limited, particularly in Latin America. A countrywide representative survey of S. aureus infections was performed in Argentina by analyzing 591 clinical isolates from 66 hospitals in a prospective cross-sectional, multicenter study (Nov-2009). This work involved healthcare-onset infections-(HAHO, >48 hospitalization hours) and community-onset (CO) infections [including both, infections (HACO) in patients with healthcare-associated risk-factors (HRFs) and infections (CACO) in those without HRFs]. MRSA strains were genetically typed as CA-MRSA and HA-MRSA genotypes (CA-MRSA(G) and HA-MRSA(G)) by SCCmec- and spa-typing, PFGE, MLST and virulence genes profile by PCR. Considering all isolates, 63% were from CO-infections and 55% were MRSA [39% CA-MRSA(G) and 16% HA-MRSAG]. A significantly higher MRSA proportion among CO- than HAHO-S. aureus infections was detected (58% vs 49%); mainly in children (62% vs 43%). The CA-MRSA(G)/HA-MRSA(G) have accounted for 16%/33% of HAHO-, 39%/13% of HACO- and 60.5%/0% of CACO-infections. Regarding the epidemiological associations identified in multivariate models for patients with healthcare-onset CA-MRSA(G) infections, CA-MRSA(G) behave like HA-MRSAG within hospitals but children were the highest risk group for healthcare-onset CA-MRSAG infections. Most CA-MRSAG belonged to two major clones: PFGE-type N-ST30-SCCmecIVc-t019-PVL+ and PFGE-type I-ST5-IV-SCCmecIVa-t311-PVL+ (45% each). The ST5-IV-PVL+/ST30-IV-PVL+ clones have caused 31%/33% of all infections, 20%/4% of HAHO-, 43%/23% of HACO- and 35%/60% of CACO- infections, with significant differences by age groups (children/adults) and geographical regions. Importantly, an isolate belonging to USA300-0114-(ST8-SCCmecIVa-spat008-PVL+-ACME(+)) was detected for the first time in Argentina. Most of HA-MRSAG (66%) were related to the Cordobes/Chilean clone-(PFGE-type A-ST5-SCCmecl-t149) causing 18% of all infections (47% of HAHO- and 13% of HACO-infections).