College of Pharmacy, The University of Texas at Austin, San Antonio, TX, USA.
Pharmacotherapy Education and Research Center, School of Medicine, The University of Texas Health Science Center, San Antonio, TX, USA.
J Antimicrob Chemother. 2017 Sep 1;72(9):2461-2468. doi: 10.1093/jac/dkx200.
Staphylococcus aureus is a major pathogen causing significant morbidity and mortality worldwide. The emergence of MDR S. aureus strains in the community setting has major implications in disease management. However, data regarding the occurrence and patterns of MDR community-associated S. aureus sub-clones is limited.
To use whole-genome sequences to describe the diversity and distribution of resistance mechanisms among community-associated S. aureus isolates.
S. aureus isolates from skin and soft tissue infections (SSTIs) and nasal colonization were collected from patients within 10 primary care clinics from 2007 to 2015. The Illumina Miseq platform was used to determine the genome sequences for 144 S. aureus isolates. Phylogenetic and bioinformatics analyses were performed using in silico tools. The resistome was assembled and compared with the phenotypically derived antibiogram.
Approximately one-third of S. aureus isolates in the South Texas primary care setting were MDR. A higher proportion of SSTI isolates were MDR in comparison with nasal colonization isolates. Individuals with MDR S. aureus SSTIs were more likely to be African American and obese. Furthermore, S. aureus populations are able to acquire and lose antimicrobial resistance genes. USA300 strains were differentiated by a stable chromosomal mutation in gyrA conferring quinolone resistance. The resistomes were highly predictive of antimicrobial resistance phenotypes.
These findings highlight the high prevalence and epidemiological factors associated with MDR S. aureus strains in the community setting and demonstrate the utility of next-generation sequencing to potentially quicken antimicrobial resistance detection and surveillance for targeted interventions.
金黄色葡萄球菌是一种主要的病原体，在全球范围内造成了很大的发病率和死亡率。社区环境中出现耐多药金黄色葡萄球菌（MDR S. aureus）菌株对疾病管理有重大影响。然而，关于社区相关耐多药金黄色葡萄球菌亚克隆的发生和模式的数据有限。
使用全基因组序列描述社区相关金黄色葡萄球菌分离株中耐药机制的多样性和分布。
从 2007 年至 2015 年，从 10 家初级保健诊所的患者中收集皮肤和软组织感染（SSTIs）和鼻腔定植的金黄色葡萄球菌分离株。使用 Illumina Miseq 平台确定 144 株金黄色葡萄球菌分离株的基因组序列。使用计算机工具进行系统发育和生物信息学分析。组装耐药组并与表型衍生的药敏谱进行比较。
在南德克萨斯州初级保健环境中，大约三分之一的金黄色葡萄球菌分离株为耐多药。与鼻腔定植分离株相比，SSTI 分离株的耐多药比例更高。耐多药金黄色葡萄球菌 SSTIs 的个体更可能是非洲裔美国人和肥胖者。此外，金黄色葡萄球菌群体能够获得和失去抗菌药物耐药基因。USA300 菌株通过在 gyrA 中稳定的染色体突变而分化，该突变赋予了喹诺酮类药物耐药性。耐药组高度预测了抗菌药物耐药表型。
这些发现强调了社区环境中耐多药金黄色葡萄球菌菌株的高流行率和与流行病学相关的因素，并展示了下一代测序在快速检测和监测抗菌药物耐药性方面的潜在应用，以进行有针对性的干预。
