Rebić Velma, Budimir Ana, Aljicević Mufida, Mahmutović Vranić Sabina, Rebić Damir
Institute of Microbiology, Faculty of Medicine, University of Sarajevo, Sarajevo, Bosnia and Herzegovina.
Department of Clinical and Molecular Microbiology, University Hospital Centre Zagreb, Zagreb, Croatia.
Cent Eur J Public Health. 2019 Mar;27(1):58-63. doi: 10.21101/cejph.a4979.
Staphylococcus aureus (SA) represents one of the most important microorganism that is part of the normal microflora of humans, but in certain conditions can cause very serious infections. Methicillin-resistant Staphylococcus aureus (MRSA) is responsible for a wide spectrum of nosocomial and community associated infections worldwide. The aim of this study was to determine community acquired MRSA (CA-MRSA), as well as the frequency of Panton-Valentine leukocidin (PVL) genes and staphylococcal cassette chromosome mec (SCCmec) types in isolates obtained from outpatients in the region of 700,000 people (Canton Sarajevo, Bosnia and Herzegovina) Methods: Our investigation included phenotypic and genotypic markers such as antimicrobial resistance, pulsed-field gel electrophoresis (PFGE), SCC typing, and PVL detection.
Antimicrobial susceptibility: all MRSA isolates were resistant to the β-lactam antibiotics tested, and all isolates were susceptible to trimethoprim sulphamethoxazole, rifampicin, fusidic acid, linezolid, and vancomycin. After the PFGE analysis, the isolates were grouped into five similarity groups: A-E. The largest number of isolates belonged to one of two groups: C - 60% and D - 27%. In both groups C and D, SCCmec type IV was predominant (60% and 88.8%, respectively). A total of 24% of the isolates had positive expression of PVL genes, while 76% showed a statistically significantly greater negative expression of PVL genes.
Using combination techniques, we were able to investigate the origin and genetic background of the strains. PFGE analysis revealed two large, genetically related groups of strains consisting of 87 isolates. Our results suggest failure to apply the screening policy, and a lack of knowledge about multiresistant MRSA strains. This study showed the local epidemiological situation which should be the basis of antimicrobial empiric therapy for non-hospitalized patients.
金黄色葡萄球菌（SA）是人类正常微生物群落中最重要的微生物之一，但在某些情况下可引起非常严重的感染。耐甲氧西林金黄色葡萄球菌（MRSA）在全球范围内导致了广泛的医院获得性感染和社区相关性感染。本研究的目的是确定社区获得性MRSA（CA-MRSA），以及从70万人（波斯尼亚和黑塞哥维那萨拉热窝州）地区的门诊患者分离株中潘顿-瓦伦丁杀白细胞素（PVL）基因和葡萄球菌盒式染色体mec（SCCmec）类型的频率。方法：我们的调查包括表型和基因型标记，如抗菌药物耐药性、脉冲场凝胶电泳（PFGE）、SCC分型和PVL检测。
抗菌药物敏感性：所有MRSA分离株对所测试的β-内酰胺类抗生素耐药，所有分离株对复方新诺明、利福平、夫西地酸、利奈唑胺和万古霉素敏感。PFGE分析后，分离株被分为五个相似组：A-E。分离株数量最多的属于两个组之一：C组-60%和D组-27%。在C组和D组中，IV型SCCmec均占主导（分别为60%和88.8%）。共有24%的分离株PVL基因表达阳性，而76%的分离株PVL基因阴性表达在统计学上显著更高。
通过联合技术，我们能够研究菌株的起源和遗传背景。PFGE分析揭示了由87株菌株组成的两个大型、遗传相关的菌株组。我们的结果表明筛查政策未得到应用，且对多重耐药MRSA菌株缺乏了解。本研究显示了当地的流行病学情况，应作为非住院患者抗菌经验性治疗的依据。
