Clinical and Epidemiologic Characteristics Cannot Distinguish Community-Associated Methicillin-Resistant Staphylococcus aureus Infection from Methicillin-Susceptible S. aureus Infection: A Prospective Investigation

Miller, Loren G.; Remington, Franciose Perdreau; Bayer, Arnold S.; Diep, Binh An; Tan, Nelly; Bharadwa, Kiran; Tsui, Jennifer; Perlroth, Joshua; Shay, Anthony; Tagudar, G.; Ibebuogu, Uzoma N.; Spellberg, Brad

doi:10.1086/511033

Cited by 224 publications

(152 citation statements)

References 52 publications

(63 reference statements)

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“…5). This finding confirms that methicillin resistance does not have an impact on virulence, as shown recently in the USA300 and USA400 clones (12,13,28) and is consistent with reports on comparable clinical outcomes observed in CA-MRSA and CA-MSSA strains (29)(30)(31). Finally, we did not detect significant differences in PSM␣3 expression between carriage vs. infection isolates, indicating that high expression of this key virulence determinant is not selected for in strains causing disease but is a general characteristic of the USA300/USA500 sublineage.…”

Section: Sequential Acquisition Of Virulence Genes By Contemporary Cc8supporting

confidence: 93%

Evolution of virulence in epidemic community-associated methicillin-resistant Staphylococcus aureus

Diep

Villaruz

et al. 2009

Proc. Natl. Acad. Sci. U.S.A.

360

373

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Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) has recently emerged worldwide. The United States, in particular, is experiencing a serious epidemic of CA-MRSA that is almost entirely caused by an extraordinarily infectious strain named USA300. However, the molecular determinants underlying the pathogenic success of CA-MRSA are mostly unknown. To gain insight into the evolution of the exceptional potential of USA300 to cause disease, we compared the phylogeny and virulence of USA300 with that of closely related MRSA clones. We discovered that the sublineage from which USA300 evolved is characterized by a phenotype of high virulence that is clearly distinct from other MRSA strains. Namely, USA300 and its progenitor, USA500, had high virulence in animal infection models and the capacity to evade innate host defense mechanisms. Furthermore, our results indicate that increased virulence in the USA300/USA500 sublineage is attributable to differential expression of core genome-encoded virulence determinants, such as phenol-soluble modulins and ␣-toxin. Notably, the fact that the virulence phenotype of USA300 was already established in its progenitor indicates that acquisition of mobile genetic elements has played a limited role in the evolution of USA300 virulence and points to a possibly different role of those elements. Thus, our results highlight the importance of differential gene expression in the evolution of USA300 virulence. This finding calls for a profound revision of our notion about CA-MRSA pathogenesis at the molecular level and has important implications for design of therapeutics directed against CA-MRSA.

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Section: Sequential Acquisition Of Virulence Genes By Contemporary Cc8supporting

confidence: 93%

Evolution of virulence in epidemic community-associated methicillin-resistant Staphylococcus aureus

Diep

Villaruz

et al. 2009

Proc. Natl. Acad. Sci. U.S.A.

360

373

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“…Clinical variables were not different between MRSA and MSSA subgroups. None of the clinical variables could predict MRSA infection at admission like other studies [10,11].…”

Section: Discussioncontrasting

confidence: 52%

Risk factors associated with Methicillin-resistant Staphylococcus aureus infection in children

2015

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Objective: To identify the clinical variables that differentiate MRSA (Methicillin-resistant Staphylococcus aureus) from MSSA (Methicillin-sensitive S. aureus) infection. Methods: Cases having culture isolates of Staphylococcus species were recruited. Baseline and other laboratory parameters were compared between MSSA and MRSA sub-groups to identify the predictors for MRSA. Results: Out of 98 isolates of S.aureus, 46 (47%) were MRSA. Significant leukocytosis was found in cases with MRSA (P <0.03). None of the other clinical variables could differentiate MRSA from MSSA infection. Conclusion: Presence of leukocytosis was twice more likely to predict MRSA than MSSA at admission. Empiric therapy must be guided by antimicrobial sensitivity pattern of regional culture isolates.

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“…and incarceration, though overall, clinical and epidemiological risk factors could not reliably distinguish between MRSA and MSSA infection [27]. Among children, a prospective study from Texas did not find any significant risk factors, though the assessment was limited to that of healthcare-related risk factors [13].…”

Section: Discussionmentioning

confidence: 95%

Epidemiologic Similarities in Pediatric Community-Associated Methicillin-Resistant and Methicillin-Sensitive Staphylococcus aureus in the San Francisco Bay Area

Hsiang

Shiau

Nadle³

et al. 2012

Journal of the Pediatric Infectious Diseases Society

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Clinical and Epidemiologic Characteristics Cannot Distinguish Community-Associated Methicillin-Resistant Staphylococcus aureus Infection from Methicillin-Susceptible S. aureus Infection: A Prospective Investigation

Cited by 224 publications

References 52 publications

Evolution of virulence in epidemic community-associated methicillin-resistant Staphylococcus aureus

Evolution of virulence in epidemic community-associated methicillin-resistant Staphylococcus aureus

Risk factors associated with Methicillin-resistant Staphylococcus aureus infection in children

Epidemiologic Similarities in Pediatric Community-Associated Methicillin-Resistant and Methicillin-Sensitive Staphylococcus aureus in the San Francisco Bay Area

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