Selection for qacA carriage in CC22, but not CC30, methicillin-resistant Staphylococcus aureus bloodstream infection isolates during a successful institutional infection control programme

Otter, Jonathan A.; Patel, Amita; Cliff, Penelope R.; Halligan, Eugene; Tosas, Olga; Edgeworth, Jonathan D

doi:10.1093/jac/dks500

Cited by 47 publications

(46 citation statements)

References 35 publications

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“…This conclusion is contrary to theories surrounding the dissemination of LA-MRSA ST398 in Europe and, considering the presence of czrC in LA-MRSA ST398 isolates in the United States, indicates a potential link between the genetic lineage and the carriage of specific resistance markers, such as that seen for qacA resistance in CC22 in the hospital setting (30). Furthermore, the data reported here indicate that multiple mechanisms contribute to fitness and the ability of LA-MRSA ST5 and other lineages to compete and to persist in the nasal microbiota of pigs.…”

Section: Discussioncontrasting

confidence: 86%

“…Although some causal role of antibiotic use in the emergence of LA-MRSA is hypothesized and may seem obvious, epidemiological evidence of such relationships has not been readily demonstrated (28). It is clear that other factors, including disinfectants and metals, may play selective roles in the emergence of particular MRSA clones in humans and animals (20,29,30). In this study, zinc resistance mediated by the czrC gene was examined as a potential contributor to the prevalence of LA-MRSA ST5 on swine farms in the United States.…”

Section: Discussionmentioning

confidence: 99%

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Zinc Resistance within Swine-Associated Methicillin-Resistant Staphylococcus aureus Isolates in the United States Is Associated with Multilocus Sequence Type Lineage

Hau

Frana

Sun

et al. 2017

Appl Environ Microbiol

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Zinc resistance in livestock-associated methicillin-resistant Staphylococcus aureus (LA-MRSA) sequence type 398 (ST398) is primarily mediated by the czrC gene colocated with the mecA gene, encoding methicillin resistance, within the type V staphylococcal cassette chromosome mec (SCCmec) element. Because czrC and mecA are located within the same mobile genetic element, it has been suggested that the use of zinc in feed as an antidiarrheal agent has the potential to contribute to the emergence and spread of methicillin-resistant S. aureus (MRSA) in swine, through increased selection pressure to maintain the SCCmec element in isolates obtained from pigs. In this study, we report the prevalence of the czrC gene and phenotypic zinc resistance in U.S. swine-associated LA-MRSA ST5 isolates, MRSA ST5 isolates from humans with no swine contact, and U.S. swine-associated LA-MRSA ST398 isolates. We demonstrated that the prevalence of zinc resistance in U.S. swineassociated LA-MRSA ST5 isolates was significantly lower than the prevalence of zinc resistance in MRSA ST5 isolates from humans with no swine contact and swineassociated LA-MRSA ST398 isolates, as well as prevalences from previous reports describing zinc resistance in other LA-MRSA ST398 isolates. Collectively, our data suggest that selection pressure associated with zinc supplementation in feed is unlikely to have played a significant role in the emergence of LA-MRSA ST5 in the U.S. swine population. Additionally, our data indicate that zinc resistance is associated with the multilocus sequence type lineage, suggesting a potential link between the genetic lineage and the carriage of resistance determinants.IMPORTANCE Our data suggest that coselection thought to be associated with the use of zinc in feed as an antimicrobial agent is not playing a role in the emergence of livestock-associated methicillin-resistant Staphylococcus aureus (LA-MRSA) ST5 in the U.S. swine population. Additionally, our data indicate that zinc resistance is more associated with the multilocus sequence type lineage, suggesting a potential link between the genetic lineage and the carriage of resistance markers. This information is important for public health professionals, veterinarians, producers, and consumers.

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Section: Discussioncontrasting

confidence: 86%

Section: Discussionmentioning

confidence: 99%

Zinc Resistance within Swine-Associated Methicillin-Resistant Staphylococcus aureus Isolates in the United States Is Associated with Multilocus Sequence Type Lineage

Hau

Frana

Sun

et al. 2017

Appl Environ Microbiol

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“…The high rate of qac gene carriage in ST 239 associated with an MRSA outbreak has been noted previously in an ICU in the United Kingdom, where the initiation of daily chlorhexidine bathing for all patients was associated with greatly reduced transmission of endemic UK clones but no reduction in the transmission of ST 239 Cooper et al 2012). Recent studies have determined that carriage of plasmid borne qac genes can confer at least tolerance, and possibly resistance, to widely used antiseptics such as chlorhexidine gluconate, and may provide a selective advantage in the nosocomial environment (Smith et al 2008;Batra et al 2010;Lee et al 2011;Otter et al 2013). Where there are no broadly available means of phenotypic identification of resistance, such as with quaternary ammonium compounds, WGS allows for the detection of genetic elements associated with resistance.…”

Section: Discussionmentioning

confidence: 84%

Genome sequencing defines phylogeny and spread of methicillin-resistant Staphylococcus aureus in a high transmission setting

et al. 2014

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Methicillin-resistant Staphylococcus aureus (MRSA) is a major cause of nosocomial infection. Whole-genome sequencing of MRSA has been used to define phylogeny and transmission in well-resourced healthcare settings, yet the greatest burden of nosocomial infection occurs in resource-restricted settings where barriers to transmission are lower. Here, we study the flux and genetic diversity of MRSA on ward and individual patient levels in a hospital where transmission was common. We repeatedly screened all patients on two intensive care units for MRSA carriage over a 3-mo period. All MRSA belonged to multilocus sequence type 239 (ST 239). We defined the population structure and charted the spread of MRSA by sequencing 79 isolates from 46 patients and five members of staff, including the first MRSA-positive screen isolates and up to two repeat isolates where available. Phylogenetic analysis identified a flux of distinct ST 239 clades over time in each intensive care unit. In total, five main clades were identified, which varied in the carriage of plasmids encoding antiseptic and antimicrobial resistance determinants. Sequence data confirmed intra-and interwards transmission events and identified individual patients who were colonized by more than one clade. One patient on each unit was the source of numerous transmission events, and deep sampling of one of these cases demonstrated colonization with a ''cloud'' of related MRSA variants. The application of whole-genome sequencing and analysis provides novel insights into the transmission of MRSA in under-resourced healthcare settings and has relevance to wider global health.

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“…While there are no established breakpoints for chlorhexidine resistance, the presence of these genes has been associated both with increased MICs and with untoward clinical outcomes (35)(36)(37)(38). Interestingly, multiple reports have identified chlorhexidine-resistant S. aureus isolates with MICs of Ն4 g/ml (30,31,38).…”

mentioning

confidence: 99%

Recurrent Methicillin-Resistant Staphylococcus aureus Cutaneous Abscesses and Selection of Reduced Chlorhexidine Susceptibility during Chlorhexidine Use

et al. 2015

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Selection for qacA carriage in CC22, but not CC30, methicillin-resistant Staphylococcus aureus bloodstream infection isolates during a successful institutional infection control programme

Cited by 47 publications

References 35 publications

Zinc Resistance within Swine-Associated Methicillin-Resistant Staphylococcus aureus Isolates in the United States Is Associated with Multilocus Sequence Type Lineage

Zinc Resistance within Swine-Associated Methicillin-Resistant Staphylococcus aureus Isolates in the United States Is Associated with Multilocus Sequence Type Lineage

Genome sequencing defines phylogeny and spread of methicillin-resistant Staphylococcus aureus in a high transmission setting

Recurrent Methicillin-Resistant Staphylococcus aureus Cutaneous Abscesses and Selection of Reduced Chlorhexidine Susceptibility during Chlorhexidine Use

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