Molecular characterization of methicillin-resistant Staphylococcus aureus (MRSA) nasal colonization and infection isolates in a Veterans Affairs hospital

Antimicrobial Resistance and Infection Control

Tara C Smith⁴  Eli N Perencevich³  Marin L Schweizer³  Margaret Carrel²  Brett M Forshey¹  Kalyani E Eko¹ 

[1]Department of Epidemiology, University of Iowa College of Public Health, Iowa City 52246, IA, USA

[2]Department of Geographical & Sustainability Sciences, University of Iowa, Iowa City 52242, IA, USA

[3]Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City 52246, IA, USA

[4]Department of Biostatistics, Environmental Health Sciences and Epidemiology, College of Public Health, Kent State University, Kent 44242, OH, USA

关键词: Infection control;    Hospital acquired infections;    MRSA;    Staphylococcus aureus;   

Others  :  1147436
DOI  :  10.1186/s13756-015-0048-5

 received in 2014-12-31, accepted in 2015-03-13,  发布年份 2015

【 摘 要 】

Background

Nasal colonization with methicillin-resistant Staphylococcus aureus (MRSA) is associated with increased infection risk, yet colonization and infection isolates are rarely compared within the same study. The objectives of this study were to compare colonization and infection isolates from a Veterans Administration hospital in Iowa, and to determine the prevalence of livestock-associated MRSA (LA-MRSA) colonization and infection in a state with high livestock density.

Methods

All patients with available MRSA isolates collected through routine nasal screening (73%; n = 397) and from infections (27%; n = 148) between December 2010 and August 2012 were included and tested for spa type and presence of PVL and mecA genes. Clinical isolates were tested for antibiotic resistance patterns. Paired colonization and infection isolates were compared for genetic and phenotypic congruity.

Results

The most common spa types were t002 (and other CC5-associated strains; 65%) and t008 (and other CC8-associated strains; 20%). No classic LA-MRSA spa types were identified. CC5-associated strains were less likely to be associated with infections (22%; 77/353) compared with CC8-associated strains (49%; 53/109). MRSA colonization was more common among patients with infections (71%) compared with the general screening population (7%). In most cases (82%; 28/34), paired colonization and infection isolates were genetically and phenotypically indistinguishable.

Conclusions

Our data demonstrate a direct link between antecedent nasal colonization and subsequent MRSA infection. Further, our data indicate variability in colonization and infection efficiency among MRSA genotypes, which points to the need to define the molecular determinants underlying emergence of S. aureus strains in the community and nosocomial setting.

【 授权许可】

   
2015 Eko et al.; licensee BioMed Central.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]Hidron AI, Edwards JR, Patel J, Hornan TC, Sievert DM, Pollock DA et al.. NHSN annual update: antimicrobial-resistant pathogens associated with healthcare-associated infections: annual summary of data reported to the National Healthcare Safety Network at the Centers for Disease Control and Prevention, 2006-2007. Infect Control Hosp Epidemiol. 2008; 29:996-1011.
• [2]Jain R, Kralovic SM, Evans ME, Ambrose M, Simbartl LA, Obrosky DS et al.. Veterans Affairs initiative to prevent methicillin-resistant Staphylococcus aureus infections. N Engl J Med. 2011; 364:1419-30.
• [3]Gorwitz RJ, Kruszon-Moran D, McAllister SK, McQuillan G, McDougal LK, Fosheim GE et al.. Changes in the prevalence of nasal colonization with Staphylococcus aureus in the United States, 2001-2004. J Infect Dis. 2008; 197:1226-34.
• [4]Quezada Joaquin NM, Diekema DJ, Perencevich EN, Bailey G, Winokur PL, Schweizer ML. Long-term risk for readmission, methicillin-resistant Staphylococcus aureus (MRSA) infection, and death among MRSA-colonized veterans. Antimicrob Agents Chemother. 2013; 57:1169-72.
• [5]Davis KA, Stewart JJ, Crouch HK, Florez CE, Hospenthal DR. Methicillin-resistant Staphylococcus aureus (MRSA) nares colonization at hospital admission and its effect on subsequent MRSA infection. Clin Infect Dis. 2004; 39:776-82.
• [6]Safdar N, Bradley EA. The risk of infection after nasal colonization with Staphylococcus aureus. Am J Med. 2008; 121:310-5.
• [7]Perencevich EN. Deconstructing the Veterans Affairs MRSA prevention bundle. Clin Infect Dis. 2012; 54:1621-3.
• [8]Smith TC, Male MJ, Harper AL, Kroeger JS, Tinkler GP, Moritz ED et al.. Methicillin-resistant Staphylococcus aureus (MRSA) strain ST398 is present in midwestern U.S. swine and swine workers. PLoS One. 2009; 4:e4258.
• [9]Smith TC, Gebreyes WA, Abley MJ, Harper AL, Forshey BM, Male MJ et al.. Methicillin-resistant Staphylococcus aureus in pigs and farm workers on conventional and antibiotic-free swine farms in the USA. PLoS One. 2013; 8:e63704.
• [10]Carrel M, Schweizer ML, Sarrazin MV, Smith TC, Perencevich EN. Residential proximity to large numbers of swine in feeding operations is associated with increased risk of methicillin-resistant Staphylococcus aureus colonization at time of hospital admission in rural Iowa veterans. Infect Control Hosp Epidemiol. 2014; 35:190-3.
• [11]Clarridge JE, Harrington AT, Roberts MC, Soge OO, Maquelin K. Impact of strain typing methods on assessment of relationship between paired nares and wound isolates of methicillin-resistant Staphylococcus aureus. J Clin Microbiol. 2013; 51:224-31.
• [12]Riedel S, Von Stein D, Richardson K, Page J, Miller S, WInokur P et al.. Development of a prediction rule for methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococcus carriage in a Veterans Affairs Medical Center population. Infect Control Hosp Epidemiol. 2008; 29:969-71.
• [13]Boşgelmez-Tinaz G, Ulusoy S, Aridoğan B, Coşkun-Ari F. Evaluation of different methods to detect oxacillin resistance in Staphylococcus aureus and their clinical laboratory utility. Eur J Clin Microbiol Infect Dis. 2006; 25:410-2.
• [14]Lina G, Piémont Y, Godail-Gamot F, Bes M, Peter MO, Gauduchon V et al.. Involvement of Panton-Valentine leukocidin-producing Staphylococcus aureus in primary skin infections and pneumonia. Clin Infect Dis. 1999; 29:1128-32.
• [15]Stegger M, Liu CM, Larsen J, Soldanova K, Aziz M, Contente-Cuomo T et al.. Rapid differentiation between livestock-associated and livestock-independent Staphylococcus aureus CC398 clades. PLoS One. 2013; 8:e79645.
• [16]Chroboczek T, Boisset S, Rasigade J-P, Tristan A, Bes M, Meugnier H et al.. Clonal complex 398 methicillin susceptible Staphylococcus aureus: a frequent unspecialized human pathogen with specific phenotypic and genotypic characteristics. PLoS One. 2013; 8:e68462.
• [17]Koreen L, Ramaswamy SV, Graviss EA, Naidich S, Musser JM, Kreiswirth BN. spa typing method for discriminating among Staphylococcus aureus isolates: implications for use of a single marker to detect genetic micro- and macrovariation. J Clin Microbiol. 2004; 42:792-9.
• [18]Mellmann A, Weniger T, Berssenbrügge C, Rothgänger J, Sammeth M, Stove J et al.. Based Upon Repeat Pattern (BURP): an algorithm to characterize the long-term evolution of Staphylococcus aureus populations based on spa polymorphisms. BMC Microbiol. 2007; 7:98. BioMed Central Full Text
• [19]Monecke S, Coombs G, Shore AC, Coleman DC, Akpaka P, Borg M et al.. A field guide to pandemic, epidemic and sporadic clones of methicillin-resistant Staphylococcus aureus. PLoS One. 2011; 6:e17936.
• [20]Methods for Dilution Antimicrobial Susceptibility Tests for Bacteria that Grow Aerobically, Approved Standard M07-A7. Clinical and Laboratory Standards Institute, Villanova, PA; 2009.
• [21]Rinsky JL, Nadimpalli M, Wing S, Hall D, Baron D, Price LB et al.. Livestock-associated methicillin and multidrug resistant Staphylococcus aureus is present among industrial, not antibiotic-free livestock operation workers in North Carolina. PLoS One. 2013; 8:e67641.
• [22]Frana TS, Beahm AR, Hanson BM, Kinoyn JM, Layman LL, Karriker LA et al.. Isolation and characterization of methicillin-resistant Staphylococcus aureus from pork farms and visiting veterinary students. PLoS One. 2013; 8:e53738.
• [23]Khanna T, Friendship R, Dewey C, Weese JS. Methicillin resistant Staphylococcus aureus colonization in pigs and pig farmers. Vet Microbiol. 2008; 128:298-303.
• [24]Molla B, Byrne M, Abley M, Mathews J, Jackson CR, Fedorka-Cray P et al.. Epidemiology and genotypic characteristics of methicillin-resistant Staphylococcus aureus strains of porcine origin. J Clin Microbiol. 2012; 50:3687-93.
• [25]Mest DR, Wong DH, Shimoda KJ, Mulligan ME, Wilson SE. Nasal colonization with methicillin-resistant Staphylococcus aureus on admission to the surgical intensive care unit increases the risk of infection. Anesth Analg. 1994; 78:644-50.
• [26]Roghmann MC, Siddiqui A, Plaisance K, Standiford H. MRSA colonization and the risk of MRSA bacteraemia in hospitalized patients with chronic ulcers. J Hosp Infect. 2001; 47:98-103.
• [27]Ajao AO, Harris AD, Johnson JK, Roghmann MC, Perencevich EN, Schweizer ML et al.. Association between methicillin-resistant Staphylococcus aureus colonization and infection may not differ by age group. Infect Control Hosp Epidemiol. 2013; 34:93-5.
• [28]Diekema DJ, Richter SS, Heilmann KP, Dohrn CL, Riahi F, Tendolkar S et al.. Continued emergence of USA300 methicillin-resistant Staphylococcus aureus in the United States: results from a nationwide surveillance study. Infect Control Hosp Epidemiol. 2014; 35:285-92.
• [29]DeLeo FR, Otto M, Kreiswirth BN, Chambers HF. Community-associated meticillin-resistant Staphylococcus aureus. Lancet. 2010; 375:1557-68.
• [30]Schinasi L, Wing S, Augustino KL, Ramsey KM, Nobles DL, Richardson DB et al.. A case control study of environmental and occupational exposures associated with methicillin resistant Staphylococcus aureus nasal carriage in patients admitted to a rural tertiary care hospital in a high density swine region. Environ Health. 2014; 13:54. BioMed Central Full Text
• [31]Casey JA, Curriero FC, Cosgrove SE, Nachman KE, Schwartz BS. High-density livestock operations, crop field application of manure, and risk of community-associated methicillin-resistant Staphylococcus aureus infection in Pennsylvania. JAMA Intern Med. 2013; 173:1980-90.
• [32]Casey JA, Shopsin B, Cosgrove SE, Nachman KE, Curriero FC, Rose HR et al.. High-density livestock production and molecularly characterized MRSA infections in Pennsylvania. Environ Health Perspect. 2014; 122:464-70.
• [33]Osadebe LU, Hanson B, Smith TC, Heimer R. Prevalence and characteristics of Staphylococcus aureus in Connecticut swine and swine farmers. Zoonoses Public Health. 2013; 60:234-43.
• [34]Hallin M, Deplano A, Denis O, De Mendonça R, De Ryck R, Struelens MJ. Validation of pulsed-field gel electrophoresis and spa typing for long-term, nationwide epidemiological surveillance studies of Staphylococcus aureus infections. J Clin Microbiol. 2007; 45:127-33.
• [35]Strommenger B, Kettlitz C, Weniger T, Harmsen D, Friedrich AW, Witte W. Assignment of Staphylococcus isolates to groups by spa typing, SmaI macrorestriction analysis, and multilocus sequence typing. J Clin Microbiol. 2006; 44:2533-40.