Statens Serum Institut, Copenhagen, Denmark.
Translational Genomics Research Institute, Flagstaff, Arizona.
Clin Infect Dis. 2017 Oct 1;65(7):1072-1076. doi: 10.1093/cid/cix504.
Livestock-associated methicillin-resistant Staphylococcus aureus clonal complex 398 (LA-MRSA CC398) is causing an increasing number of skin and soft tissue infections (SSTIs) in Denmark and other European countries with industrial pig production. Yet, its impact on MRSA bloodstream infections (BSIs) has not been well studied.
We investigated the clinical epidemiology of all human cases of LA-MRSA CC398 BSI during 2010-2015. Cases of LA-MRSA CC398 BSI were compared to cases of BSI caused by other types of MRSA and cases of SSTI caused by LA-MRSA CC398. Whole-genome sequence analysis was used to assess the phylogenetic relationship among LA-MRSA CC398 isolates from Danish pigs and cases of BSI and SSTI.
The number of LA-MRSA CC398 BSIs and SSTIs increased over the years, peaking in 2014, when LA-MRSA CC398 accounted for 16% (7/44) and 21% (211/985) of all MRSA BSIs and SSTIs, corresponding to 1.2 and 37.4 cases of BSI and SSTI per 1000000 person-years, respectively. Most patients with LA-MRSA CC398 BSI had no contact to livestock, although they tended to live in rural areas. LA-MRSA CC398 caused 24.3 BSIs per 1000 SSTIs among people with no livestock contact, which is similar to the ratio observed for other types of MRSA. Whole-genome sequence analysis showed that most of the BSI and SSTI isolates were closely related to Danish pig isolates.
This study demonstrates that the increasing number of LA-MRSA CC398 BSIs occurred in parallel with a much larger wave of LA-MRSA CC398 SSTIs and an expanding pig reservoir.
与牲畜相关的耐甲氧西林金黄色葡萄球菌克隆复合体 398（LA-MRSA CC398）在丹麦和其他具有工业化养猪生产的欧洲国家导致越来越多的皮肤和软组织感染（SSTIs）。然而，其对耐甲氧西林金黄色葡萄球菌血流感染（BSIs）的影响尚未得到充分研究。
我们调查了 2010-2015 年期间所有人类 LA-MRSA CC398 BSI 病例的临床流行病学。将 LA-MRSA CC398 BSI 病例与其他类型的 MRSA BSI 病例和 LA-MRSA CC398 引起的 SSTI 病例进行比较。全基因组序列分析用于评估丹麦猪和 BSI 和 SSTI 病例中 LA-MRSA CC398 分离株的系统发育关系。
LA-MRSA CC398 BSI 和 SSTI 的数量逐年增加，2014 年达到高峰，当时 LA-MRSA CC398 占所有 MRSA BSI 和 SSTI 的 16%（7/44）和 21%（211/985），相当于每 100 万人中有 1.2 和 37.4 例 BSI 和 SSTI，分别。大多数 LA-MRSA CC398 BSI 患者与牲畜没有接触，尽管他们倾向于居住在农村地区。在没有与牲畜接触的人群中，LA-MRSA CC398 引起了 24.3 例 BSI 每 1000 例 SSTI，与其他类型的 MRSA 观察到的比例相似。全基因组序列分析表明，大多数 BSI 和 SSTI 分离株与丹麦猪分离株密切相关。
本研究表明，LA-MRSA CC398 BSI 的数量增加与 LA-MRSA CC398 SSTIs 的大量增加以及猪储存量的扩大同时发生。
