van der Mee-Marquet Nathalie, Epinette Christophe, Loyau Jeremy, Arnault Laurence, Domelier Anne-Sophie, Losfelt Barbara, Girard Nicole, Quentin Roland
EA 3854, IFR 136, UFR Médecine Université François-Rabelais, 2 bis boulevard Tonnelé, 37032 Tours Cedex, France.
J Clin Microbiol. 2007 Mar;45(3):851-7. doi: 10.1128/JCM.02178-06. Epub 2007 Jan 24.
We studied 358 Staphylococcus aureus strains isolated from bloodstream infections (BSI) observed during an epidemiological study covering 2,007,681 days of hospitalization in 32 healthcare institutions (HCIs) between 2004 and 2006. The strains were tested for antibiotic susceptibility and characterized genetically. The incidence of S. aureus BSI declined regularly through 2004 and 2005 and then significantly increased in 2006 (+80%). This was largely due to an increase in BSI involving methicillin-sensitive S. aureus (MSSA) strains and nonmultiresistant methicillin-resistant S. aureus (NORSA) strains. Ninety-six percent of the NORSA strains were resistant only to methicillin and fluoroquinolones. Most of the MSSA strains belonged to a small number of pulsed-field gel electrophoresis (PFGE) divisions and were associated with epidemic phenomena in HCIs. The NORSA strains also clustered into a limited number of PFGE divisions but could not be related to any local outbreak in HCIs. In 2006, there was a significant increase in the incidence of BSI associated with tst gene-positive MSSA strains (+275%) and the first three BSI associated with tst gene-positive MRSA were observed. PFGE data revealed a limited heterogeneity among the tst gene-positive strains without any outbreak in the HCIs. Our study underlines the need for infection control teams to focus efforts on preventing both MRSA and MSSA BSI. As recently demonstrated in vitro, fluoroquinolones may enhance horizontal transfer of virulence and antibiotic resistance genes. These antibiotics are widely used in France, so our findings raise the issue of whether their use has contributed to the acquisition of mecA and tst genes by S. aureus strains.
我们研究了358株从血流感染(BSI)中分离出的金黄色葡萄球菌菌株,这些感染是在2004年至2006年期间对32家医疗机构(HCI)的2,007,681天住院时间进行的一项流行病学研究中观察到的。对这些菌株进行了抗生素敏感性测试并进行了基因特征分析。2004年和2005年期间,金黄色葡萄球菌BSI的发病率呈规律性下降,然后在2006年显著上升(+80%)。这主要是由于涉及甲氧西林敏感金黄色葡萄球菌(MSSA)菌株和非多重耐药甲氧西林耐药金黄色葡萄球菌(NORSA)菌株的BSI增加。96%的NORSA菌株仅对甲氧西林和氟喹诺酮耐药。大多数MSSA菌株属于少数脉冲场凝胶电泳(PFGE)分型,并与HCI中的流行现象相关。NORSA菌株也聚集成有限数量的PFGE分型,但与HCI中的任何局部暴发无关。2006年,与tst基因阳性MSSA菌株相关的BSI发病率显著增加(+275%),并首次观察到3例与tst基因阳性MRSA相关的BSI。PFGE数据显示tst基因阳性菌株之间的异质性有限,HCI中没有暴发。我们的研究强调感染控制团队需要集中精力预防MRSA和MSSA BSI。正如最近在体外所证明的,氟喹诺酮可能会增强毒力和抗生素耐药基因的水平转移。这些抗生素在法国广泛使用,因此我们的研究结果提出了它们的使用是否促成金黄色葡萄球菌菌株获得mecA和tst基因的问题。