Clonal nature and diversity of resistance, toxins and adhesins genes of meticillin-resistant Staphylococcus aureus collected in a Spanish hospital
Highlights
► We determine the prevalence of pathogenicity genes among 189 MRSA isolates. ► 91 Virulence, 42 resistance and 22 set/ssl genes profiles were detected. ► We observed a correspondence relationship between clones and pathogenicity genes. ► Changes in molecular epidemiology in our institution were produced over time. ► We reported the pathogenic potential of prevalent MRSA clones in Spanish hospitals.
Introduction
Methicillin-resistant Staphylococcus aureus (MRSA) has become established as one of the most prevalent pathogen in hospitals worldwide. Aspects related to these infections have important epidemiologic, therapeutic and clinical implications, both from the perspective of its pathogenicity as well as from the evolution of antimicrobial resistance. In the past two decades, MRSA strains have generally been confined to healthcare settings (HA-MRSA) and have predominantly affected individuals with co-morbidity or other specific risk factors, such as prolonged hospital stay and nursing home residency (Elston and Barlow, 2009). However, over the years, MRSA infection epidemiology has undergone important changes. Novel strains have also emerged outside of the hospital setting, in the community (CA-MRSA) (David and Daum, 2010), and more recently livestock animals have been described as a novel source of human MRSA colonization and infection (LA-MRSA) (Graveland et al., 2011). CA-MRSA and LA-MRSA have become a challenge for countries that have so far maintained low rates of MRSA (Stefani et al., 2012). Also, CA-MRSA strains are gradually becoming entrenched as nosocomial pathogens and that both CA-MRSA and HA-MRSA strains now circulate in both environments (David et al., 2008).
The evolution of new human and animal pathogenic strains of S. aureus has been due to the accumulation of mobile genetic elements encoding methicillin resistance and virulence factors into successful lineages (Lindsay, 2010). Also, recent analyses have shown that all S. aureus genotypes that efficiently colonize humans have given rise to life-threatening pathogens, but that some clonal lineages appear to be more virulent than others (Holtfreter et al., 2007). Comparative genomics has been an increasingly important approach for scientists to improve knowledge on the pathogenesis and drug resistance of S. aureus.
The aim of this study was to characterise both resistance and virulence genetic profiles of MRSA clones isolated in a third level hospital in Valladolid, Spain between 2005 and 2008, in order to obtain an insight into the presence and genetic characteristics of epidemic MRSA strains in Spain
Section snippets
Bacterial isolates
A total of 189 non repeated MRSA isolates recovered from clinical samples were collected in 2005, 2007 and 2008 at the University Clinic Hospital in Valladolid, Spain (HCUV). Isolates were considered to be nosocomially acquired in 126 cases, healthcare-associated in 47 cases, community-associated in two cases, and of uncertain mode of acquisition in fourteen. The isolates were reported to originate from skin and soft tissue infection (105 isolates), surgery infection (48), respiratory tract
Molecular typing
spa Typing of the 189 MRSA strain studied revealed 18 different spa types (Table 1). Representative MRSA isolates analyzed by MLST showed eight different sequence types (ST125, ST5, ST146, ST228, ST8, ST239, ST45 and ST97) which belonged to four clonal complexes (CC5, CC8, CC45 and CC97). The strains studied were classified as belonging to nine different HA-MRSA clones, designated by their ST followed by their SCCmec type (ST125-IV/VI, ST125-IV, ST146-IV, ST228-I, ST5-IV, ST8-IV, ST239-III,
Discussion
The vast majority of our MRSA isolates could be attributed to five clones ST125-IV/VI, ST125-IV, ST228-I, ST146-IV and ST8-IV. The ST125 isolates are currently more frequent in our hospital, as well as in other Spanish hospitals, which represents almost the 50% of MRSA isolates (Perez-Vazquez et al., 2009, Vindel et al., 2009). However, unlike that observed in other Spanish hospitals, we find that 62% of these ST125 strains harbored composite or multiple SCCmec elements including SCCmec type IV
Acknowledgements
This study was partially supported by a Grant of Roche Diagnostic.
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