Medical Microbiology and Hygiene, Department of Infectious Diseases, Heidelberg University Hospital, Im Neuenheimer Feld 324, 69120, Heidelberg, Germany.
Heidelberg Institute of Global Health, Heidelberg University Hospital, Heidelberg, Germany.
Sci Rep. 2020 Aug 6;10(1):13243. doi: 10.1038/s41598-020-70112-z.
Staphylococcus aureus is one of the major pathogens causing community-and healthcare-acquired infections. The presence of the virulence factor Panton-Valentine leukocidin (PVL) is associated with recurrent infection and clinical severity and generally regarded as a feature of community associated-methicillin-resistant Staphylococcus aureus (MRSA). To date, the focus of PVL-positive MRSA in hospitalized patients has been on outbreaks. We aimed to investigate whether PVL-positive MRSA has penetrated the community-hospital barrier by determining the prevalence of PVL in MRSA of hospitalized patients. MRSA strains isolated from patients hospitalized > 48 h in Heidelberg University Hospital between 2015 and 2018 Isolates were analysed for the presence of PVL and subjected to spa-typing. PVL-positive MRSA were then characterized by whole genome sequencing. We analysed 740 MRSA isolates in the study period and identified 6.2% (n = 46) PVL-positivity. 32.6% of PVL-positive MRSA met the criteria for nosocomial acquisition. The most frequent clones among the PVL-positive strains were ST80-t044 (21.7%, n = 10/46) and ST8-t008 (19.5%, n = 9/46). WGS identified three possible transmission clusters involving seven patients. In conclusion, we found successful epidemic PVL-positive MRSA clones entering the hospital and causing nosocomial infections. Preventive measures and constant surveillance should be maintained to prevent transmissions and clonal outbreaks.
金黄色葡萄球菌是引起社区和医院获得性感染的主要病原体之一。毒力因子 Panton-Valentine 白细胞毒素（PVL）的存在与反复感染和临床严重程度相关，通常被认为是社区相关耐甲氧西林金黄色葡萄球菌（MRSA）的特征。迄今为止，PVL 阳性 MRSA 在住院患者中的焦点一直是暴发。我们旨在通过确定住院患者中 MRSA 中 PVL 的流行率来研究 PVL 阳性 MRSA 是否已经穿透了社区-医院屏障。分析了 2015 年至 2018 年期间海德堡大学医院住院时间超过 48 小时的患者分离的 MRSA 菌株，以确定是否存在 PVL，并进行 spa 型分析。然后对 PVL 阳性 MRSA 进行全基因组测序。在研究期间分析了 740 株 MRSA 分离株，发现 6.2%（n=46）为 PVL 阳性。32.6%的 PVL 阳性 MRSA 符合医院获得性感染的标准。PVL 阳性菌株中最常见的克隆是 ST80-t044（21.7%，n=46）和 ST8-t008（19.5%，n=46）。WGS 确定了三个可能的传播集群，涉及 7 名患者。总之，我们发现成功的流行 PVL 阳性 MRSA 克隆进入医院并导致医院感染。应保持预防措施和持续监测，以防止传播和克隆暴发。
