contribution of genetically restricted, methicillin-susceptible strains to the ongoing epidemic of community-acquired Staphylococcus aureus infections - PubMed (original) (raw)
contribution of genetically restricted, methicillin-susceptible strains to the ongoing epidemic of community-acquired Staphylococcus aureus infections
Rachel C Orscheln et al. Clin Infect Dis. 2009.
Abstract
Background: Within the current worldwide epidemic of community-acquired Staphylococcus aureus infections, attention has focused on the role of methicillin-resistant strains. We characterize methicillin-susceptible strains that also contribute to this epidemic.
Methods: We tracked cultures from abscess specimens submitted to the microbiology laboratory at St. Louis Children's Hospital and examined Panton-Valentine leukocidin (PVL) genes in methicillin-susceptible S. aureus (MSSA) isolates. We further characterized some isolates by multilocus sequence typing, pulsed-field gel electrophoresis, antibiotic susceptibility, accessory gene regulator (agr) allele, and presence of the arcA gene of the arginine catabolic mobile element.
Results: From 1999 to 2007, we detected a 250-fold increase in cultures of abscesses yielding methicillin-resistant S. aureus (MRSA) and a 5-fold increase in abscess cultures yielding MSSA. MSSA isolates from abscesses and wounds were more likely to encode PVL than isolates from other sources. In contrast to PVL-negative isolates of MSSA, which were genetically diverse, PVL-positive isolates were predominantly multilocus sequence typing type 8 and agr type 1. More than half of PVL-positive MSSA isolates were resistant to erythromycin and susceptible to clindamycin with the absence of inducible resistance, a pattern uncommon in PVL-negative MSSA but frequent in the USA300 clone of MRSA. In addition, pulsed-field gel electrophoresis of PVL-positive MSSA strains revealed the USA300 pattern.
Conclusions: In addition to methicillin-resistant strains, the current epidemic of S. aureus infections includes infections caused by methicillin-susceptible strains that are closely related genetically and share phenotypic characteristics other than susceptibility to methicillin. These findings suggest that factors other than methicillin resistance are driving the epidemic.
Figures
Figure 1
Number of S. aureus isolates from abscesses at SLCH by year. While the number of MRSA isolates increased nearly exponentially over the time period studied, there was also a 5-fold increase in MSSA isolates from abscesses.
Figure 2
Multilocus sequence types for PVL-positive (left panel) and PVL-negative (right panel) MSSA strains obtained from abscesses and wounds. ST, sequence type.
Figure 3
Pulsed-field gel electrophoresis banding patterns of PVL-positive Staphylococcus aureus isolates. Antibiotic susceptibility profiles and D-test results, as measured by standard disk-diffusion techniques, are shown to the right of each gel lane. Lanes 1–5 and 7 represent PVL-positive MSSA isolates with representative antibiotic susceptibility patterns. Lane 6, shown for comparison, is a PVL-positive CA-MRSA isolate. The bracket indicates a DNA fragment thought to include the SCC_mec_ cassette, and the arrow its location in CA-MRSA USA300. The dendrogram to the left of the gel shows the genetic relatedness among the strains; as a group, the seven isolates are > 87% similar. Ox, oxacillin; Pen, penicillin; Ery, erythromycin; Clin, clindamycin; Tet, tetracycline; Neg, negative; R, resistant; S, susceptible; ND, not done.
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