Multidrug-Resistant Methicillin-Resistant <i>Staphylococcus aureus</i> Associated with Bacteremia and Monocyte Evasion, Rio de Janeiro, Brazil

Viana, Alice Slotfeldt; Botelho, Ana; Moustafa, Ahmed; Boge, Craig L K; Ferreira, A.; Carvalho, Maria Cícera da Silva; Guimarães, Maria Angélica Arpon Marandino; Costa, Bruno de Souza Scramignon; Mattos, Marcos Corrêa de; Maciel, Sabrina Pires; Echevarria-Lima, Juliana; Narechania, Apurva; O’Brien, Kelsey; Ryan, Chanelle; Gerber, Jeffrey S.; Carvalho, Bernadete Teixeira Ferreira; Figueiredo, Agnes Marie Sá; Planet, Paul J.

doi:10.3201/eid2711.210097

Cited by 18 publications

(24 citation statements)

References 43 publications

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“…This clone is typically ciprofloxacin and erythromycin resistant which is in line with our results [53]. EMRSA-15 emerged in the UK three decades ago, has spread globally and has been reported in several countries worldwide [54][55][56][57]. EMRSA-15 is also the predominant clone circulating in Portuguese hospitals and, therefore, it was no surprise that this clone was also the most frequent in hospital wastewater in Portugal [18,58].…”

Section: Molecular Typingsupporting

confidence: 88%

High Frequency of the EMRSA-15 Clone (ST22-MRSA-IV) in Hospital Wastewater

et al. 2022

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Hospital wastewaters often carry multidrug-resistant bacteria and priority pathogens, such as methicillin-resistant Staphylococcus aureus (MRSA). Pathogens and antibiotic resistance genes present in wastewaters may reach the natural environment facilitating their spread. Thus, we aimed to isolate MRSA from wastewater of 3 hospitals located in the north of Portugal and to characterize the isolates regarding the antimicrobial resistance and genetic lineages. A total of 96 wastewater samples were collected over six months. The water was filtered, and the filtration membrane was immersed in BHI broth supplemented with 6.5% of NaCl and incubated. The inoculum was streaked in ORSAB agar plates for MRSA isolation. The isolates susceptibility testing was performed against 14 antimicrobial agents. The presence of resistance and virulence genes was accessed by PCR. Molecular typing was performed in all isolates. From the 96 samples, 28 (29.2%) were MRSA-positive. Most isolates had a multidrug-resistant profile and carried the mecA, blaZ, aac(6′)-Ie-aph(2″)-Ia, aph(3′)-IIIa, ermA, ermB, ermC, tetL, tetM, dfrA dfrG and catpC221 genes. Most of the isolates were ascribed to the immune evasion cluster (IEC) type B. The isolates belonged to ST22-IV, ST8-IV and ST105-II and spa-types t747, t1302, t19963, t6966, t020, t008 and tOur study shows that MRSA can be found over time in hospital wastewater. The wastewater treatment processes can reduce the MRSA load. The great majority of the isolates belonged to ST22 and spa-type t747 which suggests the fitness of these genetic lineages in hospital effluents.

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Section: Molecular Typingsupporting

confidence: 88%

High Frequency of the EMRSA-15 Clone (ST22-MRSA-IV) in Hospital Wastewater

et al. 2022

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“…Despite this is the rst report of this lineage in our hospital, it was already detected in S. aureus isolated from BSI in other Brazilian hospitals [8,9]. Viana and coworkers recently evaluated MRSA isolates from different hospitals in Rio de Janeiro, between 2014 and 2017, and observed the emergence of this SCCmecII/ST105 lineage, which has presented multidrug resistance characteristics and seems to be associated with increased evasion when exposure to monocytic cells [40].…”

Section: Discussionmentioning

confidence: 92%

Pandemic clone USA300 in a Brazilian hospital: detection of an emergent lineage among methicillin-resistant Staphylococcus aureus from bloodstream infections

Augusto

Fernandes

Oliveira

et al. 2022

Preprint

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Background Staphylococcus aureus is one of the leading causes of bloodstream infections (BSI) worldwide. In Brazil, the hospital-acquired methicillin-resistant S. aureus USA100/SCCmecII lineage replaced previously well-established clones. However, the isolation of community-associated (CA) MRSA lineages from hospitalized patients is an increasing issue. Methods Consecutive S. aureus isolates recovered from BSI episodes of patients admitted between January 2016 and December 2018 in a Brazilian teaching hospital were tested for antimicrobial resistance, characterized as their genotypic features and the clinical characteristics of the patients were evaluated. Results A total of 123 S. aureus isolates were recovered from 113 patients. All isolates were susceptible to linezolid, teicoplanin and vancomycin and 13.8% were non-susceptible for daptomycin. Vancomycin MIC50 and MIC90 = 2 mg/L was found for both MRSA and MSSA isolates. MRSA isolation rate was 30.1% (37/123), and 51.4% of them carried the SCCmecII, followed by SCCmecIV (40.5%). Among the 37 MRSA isolates, the main lineages found were USA100/SCCmecII/ST5 and ST105 (53.7%) and USA800/ST5/SCCmecIV (18.9%). Surprisingly, were detected six (16%) CA MRSA isolates belonged to USA300/ST8/SCCmecIVa and carrying pvl genes and ACME cassette type I. These patients with USA300 BSI had severe comorbidities, including cancer, most had a Charlson score ≥ 5 and attended wards where health professionals were shared. MRSA isolates were associated with hospital acquired infections (p = 0.02) in older patients (p = 0.03) and those diagnosed with hematologic cancer (p = 0.04). A total of 52 (46%) patients died, and 60% of them presented a MRSA BSI. Conclusions Pandemic MRSA USA300 was detected for the first time in our hospital, and we hypothesized its cross-transmission between patients with BSI. This lineage can be already circulating among Brazilian hospitals, highlighting the importance of surveillance programs to fight multidrug resistant and hypervirulent isolates.

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“…Although this is the first report of this lineage in our hospital, it has already been detected in S. aureus isolates from BSI in other Brazilian hospitals [ 8 , 9 ]. Viana and coworkers recently evaluated MRSA isolates from different hospitals in Rio de Janeiro, between 2014 and 2017 and observed the emergence of this SCC me cII/ST105 lineage, which has presented multidrug resistance characteristics and seems to be associated with increased evasion when exposed to monocytic cells [ 40 ].…”

Section: Discussionmentioning

confidence: 99%

Pandemic clone USA300 in a Brazilian hospital: detection of an emergent lineage among methicillin-resistant Staphylococcus aureus isolates from bloodstream infections

Augusto

Fernandes

Oliveira

et al. 2022

Antimicrob Resist Infect Control

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Background Staphylococcus aureus is one of the leading causes of bloodstream infections (BSI) worldwide. In Brazil, the hospital-acquired methicillin-resistant S. aureus USA100/SCCmecII lineage replaced the previously well-established clones. However, the emergence of community-associated (CA) MRSA lineages among hospitalized patients is an increasing issue. Methods Consecutive S. aureus isolates recovered from BSI episodes of patients admitted between January 2016 and December 2018 in a Brazilian teaching hospital were tested for antimicrobial resistance, their genotypic features were characterized, and the clinical characteristics of the patients were evaluated. Results A total of 123 S. aureus isolates were recovered from 113 patients. All isolates were susceptible to linezolid, teicoplanin and vancomycin and 13.8% were not susceptible to daptomycin. Vancomycin MIC50 and MIC90 of 2 mg/L were found for both MRSA and MSSA isolates. The MRSA isolation rate was 30.1% (37/123), and 51.4% of them carried the SCCmec type II, followed by SCCmecIV (40.5%). Among the 37 MRSA isolates, the main lineages found were USA100/SCCmecII/ST5 and ST105 (53.7%) and USA800/ST5/SCCmecIV (18.9%). Surprisingly, six (16%) CA-MRSA isolates, belonging to USA300/ST8/SCCmecIVa that carried PVL genes and the ACME cassette type I, were detected. These six patients with USA300 BSI had severe comorbidities, including cancer, and most had a Charlson score ≥ 5; furthermore, they were in wards attended by the same health professionals. MRSA isolates were associated with hospital acquired infections (p = 0.02) in more elderly patients (p = 0.03) and those diagnosed with hematologic cancer (p = 0.04). Among patients diagnosed with MRSA BSI, 19 (54.3%) died. Conclusions The pandemic MRSA USA300 was detected for the first time in the Brazilian teaching hospital under study, and its cross-transmission most probably occurred between patients with BSI. This lineage may already be circulating among other Brazilian hospitals, which highlights the importance of carrying out surveillance programs to fight multidrug resistant and hypervirulent isolates.

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Multidrug-Resistant Methicillin-Resistant Staphylococcus aureus Associated with Bacteremia and Monocyte Evasion, Rio de Janeiro, Brazil

Cited by 18 publications

References 43 publications

High Frequency of the EMRSA-15 Clone (ST22-MRSA-IV) in Hospital Wastewater

High Frequency of the EMRSA-15 Clone (ST22-MRSA-IV) in Hospital Wastewater

Pandemic clone USA300 in a Brazilian hospital: detection of an emergent lineage among methicillin-resistant Staphylococcus aureus from bloodstream infections

Pandemic clone USA300 in a Brazilian hospital: detection of an emergent lineage among methicillin-resistant Staphylococcus aureus isolates from bloodstream infections

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