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      Genomic characterization and outbreak investigations of methicillin-resistant Staphylococcus aureus in a county-level hospital in China

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          Abstract

          Methicillin-resistant Staphylococcus aureus (MRSA) is a common pathogen contributing to healthcare-associated infections, which can result in multiple sites infections. The epidemiological characteristics of MRSA exhibit variability among distinct regions and healthcare facilities. The aim of this study was to investigate the molecular epidemiology and nosocomial outbreak characteristics of MRSA in a county-level hospital in China. A total of 130 non-repetitive MRSA strains were collected from December 2020 to November 2021. Whole-genome sequencing (WGS) was performed to identify antimicrobial resistance and virulence factors. Phylogenetic analysis was conducted to ascertain genetic diversity and phylogenetic relationships. Independent transmission scenarios were determined by the phylogeny derived from single nucleotide polymorphisms (SNPs) within the core genome. All the MRSA isolates were collected from the intensive care unit (30.00%, 39/130), the department of otorhinolaryngology (10.00%, 13/130) and the department of burn unit (9.23%, 12/130). The clinical samples mainly included phlegm (53.85%, 70/130), purulent fluid (24.62%, 32/130), and secretions (8.46%, 11/130). The resistance rates to erythromycin, clindamycin and ciprofloxacin were 75.38, 40.00, and 39.23%, respectively. All the isolates belonged to 11 clonal complexes (CCs), with the major prevalent types were CC5, CC59, and CC398, accounting for 30.00% (39/130), 29.23% (38/130), and 16.92% (22/130), respectively. Twenty sequence types (STs) were identified, and ST59 (25.38%, 33/130) was the dominant lineage, followed by ST5 (23.84%, 31/130) and ST398 (16.92%, 22/130). Three different SCCmec types were investigated, most of isolates were type IV (33.85%, 44/130), followed by type II (27.69%, 36/130) and type III (0.77%, 1/130). The common clonal structures included CC5-ST5-t2460-SCCmec IIa, CC59-ST59-t437-SCCmec IV and CC398-ST398-t034-SCCmec (−), with rates of 16.92% (22/130), 14.62% (19/130), and 13.84% (18/130), respectively. Only 12 panton-valentine leucocidin (PVL) positive strains were identified. Two independent clonal outbreaks were detected, one consisting of 22 PVL-negative strains belongs to CC5-ST5-t2460-SCCmec IIa and the other consisting of 8 PVL-negative strains belongs to CC5-ST5-t311-SCCmec IIa. Overall, our study indicated that the CC5 lineage emerged as the predominant epidemic clone of MRSA, responsible for nosocomial outbreaks and transmission within a county-level hospital in China, highlighting the necessity to strengthen infection control measures for MRSA in such healthcare facilities.

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          Methicillin-resistant Staphylococcus aureus

          Since the 1960s, methicillin-resistant Staphylococcus aureus (MRSA) has emerged, disseminated globally and become a leading cause of bacterial infections in both health-care and community settings. However, there is marked geographical variation in MRSA burden owing to several factors, including differences in local infection control practices and pathogen-specific characteristics of the circulating clones. Different MRSA clones have resulted from the independent acquisition of staphylococcal cassette chromosome mec (SCCmec), which contains genes encoding proteins that render the bacterium resistant to most β-lactam antibiotics (such as methicillin), by several S. aureus clones. The success of MRSA is a consequence of the extensive arsenal of virulence factors produced by S. aureus combined with β-lactam resistance and, for most clones, resistance to other antibiotic classes. Clinical manifestations of MRSA range from asymptomatic colonization of the nasal mucosa to mild skin and soft tissue infections to fulminant invasive disease with high mortality. Although treatment options for MRSA are limited, several new antimicrobials are under development. An understanding of colonization dynamics, routes of transmission, risk factors for progression to infection and conditions that promote the emergence of resistance will enable optimization of strategies to effectively control MRSA. Vaccine candidates are also under development and could become an effective prevention measure.
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            Methicillin-Resistant Staphylococcus aureus: Molecular Characterization, Evolution, and Epidemiology

            SUMMARY Staphylococcus aureus , a major human pathogen, has a collection of virulence factors and the ability to acquire resistance to most antibiotics. This ability is further augmented by constant emergence of new clones, making S. aureus a “superbug.” Clinical use of methicillin has led to the appearance of methicillin-resistant S. aureus (MRSA). The past few decades have witnessed the existence of new MRSA clones. Unlike traditional MRSA residing in hospitals, the new clones can invade community settings and infect people without predisposing risk factors. This evolution continues with the buildup of the MRSA reservoir in companion and food animals. This review focuses on imparting a better understanding of MRSA evolution and its molecular characterization and epidemiology. We first describe the origin of MRSA, with emphasis on the diverse nature of staphylococcal cassette chromosome mec (SCC mec ). mecA and its new homologues ( mecB , mecC , and mecD ), SCC mec types (13 SCC mec types have been discovered to date), and their classification criteria are discussed. The review then describes various typing methods applied to study the molecular epidemiology and evolutionary nature of MRSA. Starting with the historical methods and continuing to the advanced whole-genome approaches, typing of collections of MRSA has shed light on the origin, spread, and evolutionary pathways of MRSA clones.
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              Emergence of antibiotic resistance Pseudomonas aeruginosa in intensive care unit; a critical review

              The emergence of antibiotic resistant bacteria in the healthcare is a serious concern. In the Healthcare premises precisely intensive care unit are major sources of microbial diversity. Recent findings have demonstrated not only microbial diversity but also drug resistant microbes largely habitat in ICU. Pseudomonas aeruginosa found as a part of normal intestinal flora and a significant pathogen responsible for wide range of ICU acquired infection in critically ill patients. Nosocomial infection associated with this organism including gastrointestinal infection, urinary tract infections and blood stream infection. Infection caused by this organism are difficult to treat because of the presence of its innate resistance to many antibiotics (β-lactam and penem group of antibiotics), and its ability to acquire further resistance mechanism to multiple class of antibiotics, including Beta-lactams, aminoglycosides and fluoroquinolones. In the molecular evolution microbes adopted several mechanism to maintain genomic plasticity. The tool microbe use for its survival is mainly biofilm formation, quorum sensing, and horizontal gene transfer and enzyme promiscuity. Such genomic plasticity provide an ideal habitat to grow and survive in hearse environment mainly antibiotics pressure. This review focus on infection caused by Pseudomonas aeruginosa, its mechanisms of resistance and available treatment options. The present study provides a systemic review on major source of Pseudomonas aeruginosa in ICU. Further, study also emphasizes virulence gene/s associated with Pseudomonas aeruginosa genome for extended drug resistance. Study gives detailed overview of antibiotic drug resistance mechanism.
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                Author and article information

                Contributors
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                URI : https://loop.frontiersin.org/people/2543321/overviewRole: Role: Role: Role: Role: Role: Role: Role: Role:
                Journal
                Front Microbiol
                Front Microbiol
                Front. Microbiol.
                Frontiers in Microbiology
                Frontiers Media S.A.
                1664-302X
                04 April 2024
                2024
                : 15
                : 1387855
                Affiliations
                [1] 1Department of Clinical Laboratory, The First People's Hospital of Wenling, Affiliated Wenling Hospital, Wenzhou Medical University , Wenling, China
                [2] 2Department of Pharmacy, Wenling Hospital of Traditional Chinese Medicine, Affiliated Wenling Traditional Chinese Medicine Hospital, Zhejiang Chinese Medical University , Wenling, China
                [3] 3Department of Critical Care Medicine, The First People's Hospital of Wenling, Affiliated Wenling Hospital, Wenzhou Medical University , Wenling, China
                [4] 4Department of Traditional Chinese Medicine, The Affiliated Xianju’s Hospital, Hangzhou Medical College , Xianju, China
                [5] 5School of Public Health, Hangzhou Medical College , Hangzhou, China
                [6] 6Burn Unit, The First People's Hospital of Wenling, Affiliated Wenling Hospital, Wenzhou Medical University , Wenling, China
                Author notes

                Edited by: Fang He, Zhejiang Provincial People's Hospital, China

                Reviewed by: Siamak Heidarzadeh, Zanjan University of Medical Sciences, Iran

                Jianfeng Wang, Affiliated Hospital of Hangzhou Normal University, China

                Raina Gergova, Medical University Sofia, Bulgaria

                *Correspondence: Haijun Cai, chjwlyy@ 123456126.com

                These authors have contributed equally to this work and share first authorship

                Article
                10.3389/fmicb.2024.1387855
                11025083
                38638904
                372a1ba3-d095-4387-87aa-badf4aaa1ea9
                Copyright © 2024 Huang, Zhu, Yan, Lin, Ding, He, Li, Ying, Shen, Jiang, Cai and Jiang.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                History
                : 18 February 2024
                : 11 March 2024
                Page count
                Figures: 5, Tables: 0, Equations: 0, References: 49, Pages: 11, Words: 7072
                Funding
                Funded by: Zhejiang Provincial Medical and Health Science and Technology Project
                Award ID: 2022RC299, 2023XY088
                Funded by: Scientific Research Fund of Wenling Science and Technology Bureau
                Award ID: 2021S00229
                Funded by: Scientific Research Fund of Taizhou Science and Technology Bureau
                Award ID: 22ywb125
                Funded by: Zhejiang Provincial Program for the Cultivation of New Health Talents
                Award ID: 2020-3-187
                Funded by: Taizhou City Program for the High-level Talent Special Support Plan
                Award ID: 2022-3-18
                The author(s) declare financial support was received for the research, authorship, and/or publication of this article. This research was supported by Zhejiang Provincial Medical and Health Science and Technology Project (2022RC299, 2023XY088), Scientific Research Fund of Wenling Science and Technology Bureau (2021S00229), Scientific Research Fund of Taizhou Science and Technology Bureau (22ywb125), Zhejiang Provincial Program for the Cultivation of New Health Talents (2020-3-187), and Taizhou City Program for the High-level Talent Special Support Plan (2022-3-18).
                Categories
                Microbiology
                Original Research
                Custom metadata
                Antimicrobials, Resistance and Chemotherapy

                Microbiology & Virology
                mrsa,whole-genome sequencing,molecular epidemiology,transmission,nosocomial outbreak,country-level hospitals

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