A comparison of methicillin-resistant and methicillin-susceptible Staphylococcus aureus reveals no clinical and epidemiological but molecular differences
Introduction
Staphylococcus aureus is a major human pathogen being responsible for a wide variety of diseases, ranging from superficial skin infections to life threatening conditions such as bacteremia, endocarditis, pneumonia, or toxic shock syndrome (Lowy, 1998). The epidemiology of S. aureus changed mainly due to the emergence of methicillin resistance in 1961. Methicillin-resistant S. aureus (MRSA) infections were increasingly common in hospitals worldwide and those at higher risk were hospitalized patients or residents of long-term care facilities. This type of infection was denominated healthcare-associated MRSA (HA-MRSA) (Deurenberg and Stobberingh, 2008). But, MRSA also emerged causing infection in the community (community-associated MRSA, CA-MRSA), affecting patients who had never been hospitalized nor had known risk factors for MRSA infection (Deleo et al., 2010, Deurenberg and Stobberingh, 2008). In the present decade, increasing evidence suggests that CA-MRSA strains are infiltrating healthcare settings in many countries all over the world (Popovich et al., 2008). In South America including Colombia, the USA300-related MRSA strains are now reported causing nosocomial infections (Jimenez et al., 2012, Reyes et al., 2009). In fact, CA-MRSA infection has become endemic and more prevalent than community-associated methicillin-susceptible S. aureus (CA-MSSA) infection (Frazee et al., 2005, King et al., 2006, Moran et al., 2005, Sattler et al., 2002). In South America, most studies have focused on the description of the molecular epidemiology of MRSA infections in hospitals and in the community. As a consequence, there is little information regarding the molecular characterization of MSSA infections in these settings (Van Dijk et al., 2002, Vivoni et al., 2006). Considering the changing epidemiology of S. aureus, this study was conducted to compare the clinical, epidemiological, and molecular features of currently circulating MSSA and MRSA strains in 3 hospitals of Medellín, Colombia. Understanding the epidemiology of MSSA and MRSA infection, particularly in developing countries where the knowledge of S. aureus transmission dynamics is probably limited, is fundamental for devising effective prevention and control strategies.
Section snippets
Institutional review board approval
The study protocol was approved by the Bioethics Committee for Human Research at Universidad de Antioquia (CBEIH-SIU) (approval No. 0841150). An informed consent to participate in the study was signed by participants, parents, and/or guardians.
Study population
An observational cross-sectional study was conducted from February 2008 to June 2010, at 3 tertiary care hospitals of varying sizes. Hospital A is a large 648-bed university hospital, hospital B is a 380-bed medium-size tertiary care center, and hospital
Results
A total of 903 S. aureus-positive cultures was obtained from patients admitted to the 3 hospitals from February 2008 to June 2010. Ninety-three patients were excluded because they did not meet the inclusion criteria; from these, 40 already had an evaluated isolate, 34 were considered colonization, 7 refused participation, and 14 had incomplete clinical information. Finally, 810 patients were enrolled, 515 (63.6%) (170 MSSA, 345 MRSA) were from hospital A, 235 from hospital B (29.0%) (78 MSSA,
Discussion
The present study constitutes a cross-sectional comparison of the epidemiological and clinical characteristics, and the genetic background of MSSA and MRSA strains isolated from patients with infections classified according to CDC definitions. It was carried out in a moment when the epidemiology and clinical manifestations of S. aureus had undergone important changes that affect medical practice and pose challenges in recognition, diagnosis, and treatment.
In Colombia, until this investigation,
Acknowledgements
This research was supported by the Departamento Administrativo de Ciencia, Tecnología e Innovación – COLCIENCIAS, Project: 1115-459-21442. Likewise, JNJ received a doctoral training grant from COLCIENCIAS.
References (38)
- et al.
Clonal spread of methicillin-resistant Staphylococcus aureus in a large geographic area of the United States
J. Hosp. Infect.
(2003) - et al.
Community-associated meticillin-resistant Staphylococcus aureus
Lancet
(2010) - et al.
The evolution of Staphylococcus aureus
Infect. Genet. Evol.
(2008) The evolution of a resistant pathogen – the case of MRSA
Curr. Opin. Pharmacol.
(2003)- et al.
High prevalence of methicillin-resistant Staphylococcus aureus in emergency department skin and soft tissue infections
Ann. Emerg. Med.
(2005) - et al.
Prediction rules to identify patients with methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococci upon hospital admission
Am. J. Infect. Control
(2004) - et al.
Secrets of success of a human pathogen: molecular evolution of pandemic clones of meticillin-resistant Staphylococcus aureus
Lancet Infect. Dis.
(2002) Performance Standards for Antimicrobial Susceptibility Testing: Nineteenth Informational Supplement. CLSI document M100-S19
(2009)- et al.
Comparison of genetic backgrounds of methicillin-resistant and -susceptible Staphylococcus aureus isolates from Portuguese hospitals and the community
J. Clin. Microbiol.
(2005) - et al.
Frequent recovery of a single clonal type of multidrug-resistant Staphylococcus aureus from patients in two hospitals in Taiwan and China
J. Clin. Microbiol.
(2003)
Staphylococcus, Micrococcus and other catalase-positive cocci
Detection of Staphylococcus aureus by polymerase chain reaction amplification of the nuc gene
J. Clin. Microbiol.
Methicillin-susceptible Staphylococcus aureus as a predominantly healthcare-associated pathogen: a possible reversal of roles?
PLoS ONE
Multilocus sequence typing for characterization of methicillin-resistant and methicillin-susceptible clones of Staphylococcus aureus
J. Clin. Microbiol.
eBURST: inferring patterns of evolutionary descent among clusters of related bacterial genotypes from multilocus sequence typing data
J. Bacteriol.
Genetic relatedness between methicillin-susceptible and methicillin-resistant Staphylococcus aureus: results of a national survey
J. Antimicrob. Chemother.
Typing of methicillin-resistant Staphylococcus aureus in a university hospital setting by using novel software for spa repeat determination and database management
J. Clin. Microbiol.
CC8 MRSA strains harboring SCCmec type IVc are predominant in Colombian hospitals
PLoS ONE
Three-year surveillance of community-acquired Staphylococcus aureus infections in children
Clin. Infect. Dis.
Cited by (22)
Community-genotype methicillin-resistant Staphylococcus aureus skin and soft tissue infections in Latin America: a systematic review
2021, Brazilian Journal of Infectious DiseasesCitation Excerpt :This lineage was also common in a small series of cases from the southern state of Rio Grande do Sul in Brazil, which borders Uruguay and Argentina.50 Furthermore, the ST30-SCCmec IV lineage seems to be constrained to southernmost LA, whereas in northern countries, such as Colombia and Guyana, the ST8-IV lineage (USA300, LA variant) has been the predominant cause of CA-MRSA infections.16,29,41,51 Studies in Guyana and Colombia revealed that more than 50% of CO-SSTIs were caused by CG-MRSA, mainly USA300-LV and its variant strains without the arginine catabolic mobile element (ACME).29
A longitudinal study shows intermittent colonization by Staphylococcus aureus with a high genetic diversity in hemodialysis patients
2021, International Journal of Medical MicrobiologyCitation Excerpt :This clone, which frequently includes community-associated strains, is becoming predominant in Colombian hospitals, displacing previously reported healthcare-associated CC5 clones. Community-associated strains have overlapped healthcare-associated clones and cause endemic hospital infections all over the world (Jimenez et al., 2012; Jiménez et al., 2013). Additionally, community-associated strains cause about 25 % of the infections in hemodialysis patients and are the main cause of infection in the skin and soft tissues, a frequent infection in this group of patients (Chua et al., 2011; Snyder and D’Agata, 2012).
Boesenbergia rotunda (L.) Mansf. extract potentiates the antibacterial activity of some β-lactams against β-lactam-resistant staphylococci
2018, Journal of Global Antimicrobial ResistanceCitation Excerpt :Resistance is mediated by expression of an additional transpeptidase enzyme, penicillin-binding protein 2a (PBP2a), encoded by the mecA gene [4] as well as by production of a β-lactamase mediated by the blaZ gene [5]. Infections caused by MRSA have higher morbidity and mortality both in community and hospital settings compared with methicillin-sensitive S. aureus [6]. Plant-derived antimicrobials have shown great potential for development of novel therapeutics [7,8].
In vitro susceptibility of methicillin-resistant Staphylococcus aureus isolates from skin and soft tissue infections to vancomycin, daptomycin, linezolid and tedizolid
2017, Brazilian Journal of Infectious DiseasesCitation Excerpt :Therefore, the aim of this study was to determine in vitro susceptibility to vancomycin, daptomycin, linezolid and tedizolid of MRSA clinical isolates from patients with skin and soft tissue infections, collected in three tertiary-care hospitals of Medellin, Colombia. Methicillin-resistant S. aureus isolates were collected in three tertiary-care hospitals of Medellin, Colombia, from February 2008 to June 2010, as part of a previous cross-sectional study.13–15 Hospitals A and B are hospitals with high level of complexity with 754 and 286 beds, respectively, which provide services in all medical specialties; whereas hospital C is a 140-bed cardiology hospital.
Diseminación de cepas Staphylococcus aureus sensible a meticilina (SASM) relacionadas genéticamente, pertenecientes al CC45, entre portadores nasales sanos de hogares infantiles de Medellín, Colombia
2016, Enfermedades Infecciosas y Microbiologia Clinica