Vindel Ana, Trincado Pilar, Cuevas Oscar, Ballesteros Carmen, Bouza Emilio, Cercenado Emilia
Servicio de Microbiología, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Spain.
Servicio de Microbiología y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, Madrid, Spain Department of Medicine, Facultad de Medicina, Universidad Complutense, Madrid, Spain.
J Antimicrob Chemother. 2014 Nov;69(11):2913-9. doi: 10.1093/jac/dku232. Epub 2014 Jul 1.
In Spain, despite the high rates of healthcare-associated methicillin-resistant Staphylococcus aureus (MRSA), the incidence of community-associated (CA) MRSA seems to be low on the basis of a small number of studies. We analysed the evolution of CA-MRSA in Spain from 2004 to 2012, and identified the clonal lineages and population structure.
The study included 8326 MRSA strains. Susceptibility to 18 antimicrobials was determined. Isolates were tested for the presence of mecA, Panton-Valentine leucocidin (PVL) and the arginine catabolic mobile element (ACME) by PCR, and typed by staphylococcal cassette chromosome mec, PFGE, spa, multilocus sequence typing and agr.
Among the 8326 isolates, 246 (2.9%) were CA-MRSA. We identified genotypically 226 PVL-positive CA-MRSA isolates (88% agr type I, 10.2% agr type III and 1.8% agr type II) and 20 PVL-negative CA-MRSA isolates (all agr type I) from children and adults (82.1% from wounds) from 13 different geographical areas. A significant increase in the rates of CA-MRSA was observed when comparing 2004-07 (0.43%) with 2008-12 (5.44%). Resistance rates were as follows: only β-lactams, 84.5%; erythromycin, 12.8%; tetracycline, 8.8%; clindamycin, 4.9%; ciprofloxacin, 3.1%; fusidic acid, 2.0%; others, 0.4%; and multiresistant, 6.2% (six isolates USA300). The strains belonged to the PVL-positive clones ST8-IVc (69.9%), ST8-IVa-ACME-positive (USA300, 8.9%), ST8-IVa-ACME-negative (0.8%), ST30-IVc (4.5%), ST80-IVc (2.0%), ST5-IVc (1.2%) and others (ST59, ST72, ST88, ST642, ST1472 and ST1829; 4.5%) and to the PVL-negative ST398-V (8.1%).
We confirm an increase in CA-MRSA in Spain, the predominance of the ST8-IVc clone, the emergence of the USA300 clone, a high genetic diversity among PVL-positive CA-MRSA isolates and the recent emergence of the pig-associated ST398-V clone.
在西班牙，尽管医疗保健相关的耐甲氧西林金黄色葡萄球菌（MRSA）感染率很高，但基于少数研究，社区相关性（CA）MRSA的发病率似乎较低。我们分析了2004年至2012年西班牙CA-MRSA的演变情况，并确定了其克隆谱系和种群结构。
该研究纳入了8326株MRSA菌株。测定了这些菌株对18种抗菌药物的敏感性。通过聚合酶链反应（PCR）检测分离株中mecA、杀白细胞素（PVL）和精氨酸分解代谢移动元件（ACME）的存在情况，并通过葡萄球菌盒式染色体mec、脉冲场凝胶电泳（PFGE）、spa分型、多位点序列分型（MLST）和agr分型进行菌株分型。
在8326株分离株中，246株（2.9%）为CA-MRSA。我们从13个不同地理区域的儿童和成人（82.1%来自伤口）中基因分型鉴定出226株PVL阳性CA-MRSA分离株（88%为agr I型，10.2%为agr III型，1.8%为agr II型）和20株PVL阴性CA-MRSA分离株（均为agr I型）。与2004 - 2007年（0.43%）相比，2008 - 2012年CA-MRSA的发病率显著增加（5.44%）。耐药率如下：仅对β-内酰胺类耐药的为84.5%；对红霉素耐药的为12.8%；对四环素耐药的为8.8%；对克林霉素耐药的为4.9%；对环丙沙星耐药的为3.1%；对夫西地酸耐药的为2.0%；对其他药物耐药的为0.4%；多重耐药的为6.2%（6株为USA300型）。这些菌株属于PVL阳性克隆ST8-IVc（69.9%）、ST8-IVa-ACME阳性（USA300，8.9%）、ST8-IVa-ACME阴性（0.8%）、ST30-IVc（4.5%）、ST80-IVc（2.0%）、ST5-IVc（1.2%）以及其他类型（ST59、ST72、ST88、ST642、ST1472和ST1829；4.5%），还有PVL阴性的ST398-V（8.1%）。
我们证实西班牙CA-MRSA有所增加，ST8-IVc克隆占主导地位，USA300克隆出现，PVL阳性CA-MRSA分离株具有高度遗传多样性，以及近期出现了与猪相关的ST398-V克隆。
