1887

Abstract

Methicillin-resistant (MRSA) screening plays a great role in preventing infections in surgical patients. This study aims to evaluate clonality, virulence and resistance of MRSA in pre- and post-liver transplantation (LT) patients. Nasal and groin swabs of 190 patients were collected. PCR for virulence genes and staphylococcal cassette chromosome (SCC) types, microarray, PFGE, multilocus sequence typing and MIC were performed. MRSA carriers were detected in 20.5 % (39/190) of the patients. However, only three colonized patients developed infections post-LT. Sixty-nine MRSA isolates were identified, and the most frequent SCC type was type II (29/69; 42.0 %). Most isolates (57/69; 82.6 %) were susceptible to trimethoprim-sulfamethoxazole (TMP/SMX) and harboured the , , and genes as determined by PCR. Five sequence types (ST) were identified among nine clones; 36.2 % (25/69) isolates belonged to a predominant clone (ST105 and SCC type II) that was susceptible to TMP/SMX, mupirocin and chlorhexidine, which had 87.9 % similarity with the New York/Japan clone. The array showed virulence difference in isolates of the same clone and patients and that colonized isolates (pre-LT patients) were less virulent than those post-LT and those infected. Therefore, despite the high frequency of MRSA colonization, infection due to MRSA was uncommon in our LT unit. MRSA isolates presented great diversity. Isolates of the same clone expressed different virulence factors by array. Colonizing isolates pre-LT expressed less virulent factors than post-LT and infecting isolates.

Loading

Article metrics loading...

/content/journal/jmm/10.1099/jmm.0.000324
2016-10-18
2020-04-05
Loading full text...

Full text loading...

/deliver/fulltext/jmm/65/10/1060.html?itemId=/content/journal/jmm/10.1099/jmm.0.000324&mimeType=html&fmt=ahah

References

  1. Baba-Moussa L., Anani L., Scheftel J. M., Couturier M., Riegel P., Haïkou N., Hounsou F., Monteil H., Sanni A., Prévost G.. 2008; Virulence factors produced by strains of Staphylococcus aureus isolated from urinary tract infections. J Hosp Infect68:32–38 [CrossRef][PubMed]
    [Google Scholar]
  2. Bert F., Bellier C., Lassel L., Lefranc V., Durand F., Belghiti J., Mentré F., Fantin B.. 2005; Risk factors for Staphylococcus aureus infection in liver transplant recipients. Liver Transpl11:1093–1099 [CrossRef][PubMed]
    [Google Scholar]
  3. Bert F., Larroque B., Paugam-Burtz C., Janny S., Durand F., Dondero F., Valla D. C., Belghiti J., Moreau R., Nicolas-Chanoine M. H.. 2010; Microbial epidemiology and outcome of bloodstream infections in liver transplant recipients: an analysis of 259 episodes. Liver Transpl16:393–401 [CrossRef][PubMed]
    [Google Scholar]
  4. Böcher S., Smyth R., Kahlmeter G., Kerremans J., Vos M. C., Skov R.. 2008; Evaluation of four selective agars and two enrichment broths in screening for methicillin-resistant Staphylococcus aureus. J Clin Microbiol46:3136–3138 [CrossRef][PubMed]
    [Google Scholar]
  5. Caiaffa-Filho H. H., Trindade P. A., Gabriela da Cunha P., Alencar C. S., Prado G. V., Rossi F., Levin A. S.. 2013; Methicillin-resistant Staphylococcus aureus carrying SCCmec type II was more frequent than the Brazilian endemic clone as a cause of nosocomial bacteremia. Diagn Microbiol Infect Dis76:518–520 [CrossRef][PubMed]
    [Google Scholar]
  6. Centers for Disease Control and Prevention 2002; Public health dispatch: vancomycin-resistant Staphylococcus aureus. MMWR51:565–567
    [Google Scholar]
  7. CLSI 2009; Methods for Dilution Antimicrobial Susceptibility Tests for Bacteria That Grow Aerobically; Approved Guideline M7-A8 Wayne, PA: Clinical and Laboratory Standards Institute;
    [Google Scholar]
  8. CLSI 2014; Performance Standards for Antimicrobial Susceptibility Testing; 22nd Informational Supplement M100–S24 Wayne, PA: Clinical Laboratory Standards Institute;
    [Google Scholar]
  9. Chini V., Foka A., Dimitracopoulos G., Spiliopoulou I.. 2007; Absolute and relative real-time PCR in the quantification of tst gene expression among methicillin-resistant Staphylococcus aureus: evaluation by two mathematical models. Lett Appl Microbiol45:479–484 [CrossRef][PubMed]
    [Google Scholar]
  10. De Oliveira L. M., Van der Heijden I. M., Golding G. R., Abdala E., Freire M. P., Rossi F., D' alburquerque L. C., Levin A. S., Costa S. F.. 2015; Staphylococcus aureus isolates colonizing and infecting cirrhotic and liver-transplantation patients: comparison of molecular typing and virulence factors. BMC Microbiol15:264 [CrossRef][PubMed]
    [Google Scholar]
  11. Desai D., Desai N., Nightingale P., Elliott T., Neuberger J.. 2003; Carriage of methicillin-resistant Staphylococcus aureus is associated with an increased risk of infection after liver transplantation. Liver Transpl9:754–759 [CrossRef][PubMed]
    [Google Scholar]
  12. Enright M. C., Day N. P., Davies C. E., Peacock S. J., Spratt B. G.. 2000; Multilocus sequence typing for characterization of methicillin-resistant and methicillin-susceptible clones of Staphylococcus aureus. J Clin Microbiol38:1008–1015[PubMed]
    [Google Scholar]
  13. Garner J. S., Jarvis W. R., Emori T. G., Horan T. C., Hughes J. M.. 1998; CDC definitions for nosocomial infections. Am J Infect Control16:128–140 Erratum in: Am J Infect Control (1998) 16, 177[CrossRef]
    [Google Scholar]
  14. Hashimoto M., Sugawara Y., Tamura S., Kaneko J., Matsui Y., Moriya K., Koike K., Makuuchi M.. 2007; Impact of new methicillin-resistant Staphylococcus aureus carriage postoperatively after living donor liver transplantation. Transplant Proc39:3271–3275 [CrossRef][PubMed]
    [Google Scholar]
  15. Hashimoto M., Sugawara Y., Tamura S., Kaneko J., Matsui Y., Moriya K., Koike K., Makuuchi M.. 2008; Methicillin-resistant Staphylococcus aureus infection after living-donor liver transplantation in adults. Transpl Infect Dis10:110–116 [CrossRef][PubMed]
    [Google Scholar]
  16. Ito T., Ma X. X., Takeuchi F., Okuma K., Yuzawa H., Hiramatsu K.. 2004; Novel type V staphylococcal cassette chromosome mec driven by a novel cassette chromosome recombinase, ccrC. Antimicrob Agents Chemother48:2637–2651 [CrossRef][PubMed]
    [Google Scholar]
  17. Jensen S. O., Lyon B. R.. 2009; Genetics of antimicrobial resistance in Staphylococcus aureus. Future Microbiol4:565–582 [CrossRef][PubMed]
    [Google Scholar]
  18. Kateete D. P., Kimani C. N., Katabazi F. A., Okeng A., Okee M. S., Nanteza A., Joloba M. L., Najjuka F. C.. 2010; Identification of Staphylococcus aureus: DNase and mannitol salt agar improve the efficiency of the tube coagulase test. Ann Clin Microbiol Antimicrob13:9–23
    [Google Scholar]
  19. Kaur D. C., Narayan P. A.. 2014; Mupirocin resistance in nasal carriage of Staphylococcus aureus among healthcare workers of a tertiary care rural hospital. Ind J Crit Care Med 18:716–721
    [Google Scholar]
  20. Kearns A. M., Seiders P. R., Wheeler J., Freeman R., Steward M.. 1999; Rapid detection of methicillin-resistant staphylococci by multiplex PCR. J Hosp Infect43:33–37 [CrossRef][PubMed]
    [Google Scholar]
  21. Kim Y. J., Kim S. I., Choi J. Y., Yoon S. K., You Y. K., Kim D. G.. 2015; Clinical significance of methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococci colonization in liver transplant recipients. Korean J Intern Med30:694–704 [CrossRef][PubMed]
    [Google Scholar]
  22. Leelaporn A., Firth N., Paulsen I. T., Skurray R. A.. 1996; IS257-mediated cointegration in the evolution of a family of staphylococcal trimethoprim resistance plasmids. J Bacteriol178:6070–6073[PubMed][CrossRef]
    [Google Scholar]
  23. Li H., Zhao C., Chen H., Zhang F., He W., Wang X., Wang Q., Yang R., Zhou D., Wang H.. 2013; Identification of gene clusters associated with host adaptation and antibiotic resistance in Chinese Staphylococcus aureus isolates by microarray-based comparative genomics. PLoS One8:e53341 [CrossRef][PubMed]
    [Google Scholar]
  24. Malachowa N., DeLeo F. R.. 2010; Mobile genetic elements of Staphylococcus aureus. Cell Mol Life Sci67:3057–3071 [CrossRef][PubMed]
    [Google Scholar]
  25. Malaviolle X., Nonhoff C., Denis O., Rottiers S., Struelens M. J.. 2008; Evaluation of disc diffusion methods and Vitek 2 automated system for testing susceptibility to mupirocin in Staphylococcus aureus. J Antimicrob Chemother62:1018–1023 [CrossRef][PubMed]
    [Google Scholar]
  26. McDanel J. S., Murphy C. R., Diekema D. J., Quan V., Kim D. S., Peterson E. M., Evans K. D., Tan G. L., Hayden M. K., Huang S. S.. 2013; Chlorhexidine and mupirocin susceptibilities of methicillin-resistant Staphylococcus aureus from colonized nursing home residents. Antimicrob Agents Chemother57:552–558 [CrossRef][PubMed]
    [Google Scholar]
  27. McDougal L. K., Steward C. D., Killgore G. E., Chaitram J. M., McAllister S. K., Tenover F. C.. 2003; Pulsed-field gel electrophoresis typing of oxacillin-resistant Staphylococcus aureus isolates from the United States: establishing a national database. J Clin Microbiol41:5113–5120 [CrossRef][PubMed]
    [Google Scholar]
  28. McNicholas S., Shore A. C., Coleman D. C., Humphreys H., Hughes D. F.. 2011; DNA microarray genotyping and virulence and antimicrobial resistance gene profiling of methicillin-resistant Staphylococcus aureus bloodstream isolates from renal patients. J Clin Microbiol49:4349–4351 [CrossRef][PubMed]
    [Google Scholar]
  29. Mulvey M. R., Chui L., Ismail J., Louie L., Murphy C., Chang N., Alfa M. Canadian Committee for the Standardization of Molecular Methods 2001; Development of a Canadian standardized protocol for subtyping methicillin-resistant Staphylococcus aureus using pulsed-field gel electrophoresis. J Clin Microbiol39:3481–3485[CrossRef]
    [Google Scholar]
  30. Okuma K., Iwakawa K., Turnidge J. D., Grubb W. B., Bell J. M., O'Brien F. G., Coombs G. W., Pearman J. W., Tenover F. C. et al. 2002; Dissemination of new methicillin-resistant Staphylococcus aureus clones in the community. J Clin Microbiol40:4289–4294 [CrossRef][PubMed]
    [Google Scholar]
  31. Oliveira D. C., De Lencastre H.. 2002; Multiplex PCR strategy for rapid identification of structural types and variants of the mec element in methicillin-resistant Staphylococcus aureus. Antimicrob Agents Chemother46:2155–2161 [CrossRef][PubMed]
    [Google Scholar]
  32. Pacheco R. L., Lobo R. D., Oliveira M. S., Farina E. F., Santos C. R., Costa S. F., Padoveze M. C., Garcia C. P., Trindade P. A. et al. 2011; Methicillin-resistant Staphylococcus aureus (MRSA) carriage in a dermatology unit. Clinics66:2071–2077 [CrossRef][PubMed]
    [Google Scholar]
  33. Paterson D. L., Rihs J. D., Squier C., Gayowski T., Sagnimeni A., Singh N.. 2003; Lack of efficacy of mupirocin in the prevention of infections with Staphylococcus aureus in liver transplant recipients and candidates. Transplantation75:194–198 [CrossRef][PubMed]
    [Google Scholar]
  34. Romanelli R. M., Clemente W. T., Lima S. S., Rezende E. M., Martinho G. H., Paiva L. F., Neves F. A., Madeira J. G., Amâncio G. C. et al. 2010; MRSA outbreak at a transplantation unit. Braz J Infect Dis14:54–59 [CrossRef][PubMed]
    [Google Scholar]
  35. Santoro-Lopes G., De Gouvêa E. F., Monteiro R. C., Branco R. C., Rocco J. R., Halpern M., Ferreira A. L., De Araújo E. G., Basto S. T. et al. 2005; Colonization with methicillin-resistant Staphylococcus aureus after liver transplantation. Liver Transpl11:203–209[CrossRef]
    [Google Scholar]
  36. Schlievert P. M., Strandberg K. L., Lin Y. C., Peterson M. L., Leung D. Y.. 2010; Secreted virulence factor comparison between methicillin-resistant and methicillin-sensitive Staphylococcus aureus, and its relevance to atopic dermatitis. J Allergy Clin Immunol125:39–49 [CrossRef][PubMed]
    [Google Scholar]
  37. Singh N., Squier C., Wannstedt C., Keyes L., Wagener M. M., Cacciarelli T.. 2006; Impact of an aggressive infection control strategy on endemic Staphylococcus aureus infection in liver transplant recipients. Infect Control Hosp Epidemiol27:122–126 [CrossRef][PubMed]
    [Google Scholar]
  38. Takatsuki M., Eguchi S., Yamanouchi K., Hidaka M., Soyama A., Miyazaki K., Tajima Y., Kanematsu T.. 2010; The outcomes of methicillin-resistant Staphylococcus aureus infection after living donor liver transplantation in a Japanese center. J Hepatobiliary Pancreat Sci17:839–843 [CrossRef][PubMed]
    [Google Scholar]
  39. Truong-Bolduc Q. C., Dunman P. M., Strahilevitz J., Projan S. J., Hooper D. C.. 2005; MgrA is a multiple regulator of two new efflux pumps in Staphylococcus aureus. J Bacteriol187:2395–2405 [CrossRef][PubMed]
    [Google Scholar]
  40. Upton A., Lang S., Heffernan H.. 2003; Mupirocin and Staphylococcus aureus: a recent paradigm of emerging antibiotic resistance. J Antimicrob Chemother51:613–617 [CrossRef][PubMed]
    [Google Scholar]
  41. Zhang K., McClure J. A., Elsayed S., Louie T., Conly J. M.. 2005; Novel multiplex PCR assay for characterization and concomitant subtyping of staphylococcal cassette chromosome mec types I to V in methicillin-resistant Staphylococcus aureus. J Clin Microbiol43:5026–5033 [CrossRef][PubMed]
    [Google Scholar]
http://instance.metastore.ingenta.com/content/journal/jmm/10.1099/jmm.0.000324
Loading
/content/journal/jmm/10.1099/jmm.0.000324
Loading

Data & Media loading...

Most cited this month

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error