Said Kamaleldin B, AlGhasab Naif Saad, Alharbi Mohammed S M, Alsolami Ahmed, Bashir Abdelhafiz I, Saleem Mohd, Syed Khaja Azharuddin Sajid, Aldakheel Dakheel F, Rakha Ehab, Alshamri Jabar A, Al-Hazimi Awdah, Alrodhaiman Adel J, Taha Taha E, Alanazi Hamad H
Department of Pathology, College of Medicine, University of Ha'il, Ha'il 55476, Saudi Arabia.
Genomics, Bioinformatics and Systems Biology, Carleton University, 1125 Colonel-By Drive, Ottawa, ON K1S 5B6, Canada.
Diagnostics (Basel). 2023 Feb 21;13(5):819. doi: 10.3390/diagnostics13050819.
The rapidly changing epidemiology of and evolution of strains with enhanced virulence is a significant issue in global healthcare. Hospital-associated methicillin-resistant (HA-MRSA) lineages are being completely replaced by community-associated (CA-MRSA) in many regions. Surveillance programs tracing the reservoirs and sources of infections are needed. Using molecular diagnostics, antibiograms, and patient demographics, we have examined the distributions of in Ha'il hospitals. Out of 274 isolates recovered from clinical specimens, 181 (66%, = 181) were MRSA, some with HA-MRSA patterns across 26 antimicrobials with almost full resistances to all beta-lactams, while the majority were highly susceptible to all non-beta-lactams, indicating the CA-MRSA type. The rest of isolates (34%, = 93) were methicillin-susceptible, penicillin-resistant MSSA lineages (90%). The MRSA in men was over 56% among total MRSA ( = 181) isolates and 37% of overall isolates ( = 102 of 274) compared to MSSA in total isolates (17.5%, = 48), respectively. However, these were 28.4% ( = 78) and 12.4% ( = 34) for MRSA and MSSA infections in women, respectively. MRSA rates per age groups of 0-20, 21-50, and >50 years of age were 15% ( = 42), 17% ( = 48), and 32% ( = 89), respectively. However, MSSA in the same age groups were 13% ( = 35), 9% ( = 25), and 8% ( = 22). Interestingly, MRSA increased proportional to age, while MSSA concomitantly decreased, implying dominance of the latter ancestors early in life and then gradual replacement by MRSA. The dominance and seriousness of MRSA despite enormous efforts in place is potentially for the increased use of beta-lactams known to enhance virulence. The Intriguing prevalence of the CA-MRSA patterns in young otherwise healthy individuals replaced by MRSA later in seniors and the dominance of penicillin-resistant MSSA phenotypes imply three types of host- and age-specific evolutionary lineages. Thus, the decreasing MSSA trend by age with concomitant increase and sub-clonal differentiation into HA-MRSA in seniors and CA-MRSA in young and otherwise healthy patients strongly support the notion of subclinal emergences from a resident penicillin-resistant MSSA ancestor. Future vertical studies should focus on the surveillance of invasive CA-MRSA rates and phenotypes.
菌株毒力增强导致的流行病学快速变化及进化是全球医疗保健领域的一个重大问题。在许多地区，医院相关的耐甲氧西林金黄色葡萄球菌（HA-MRSA）谱系正被社区相关的耐甲氧西林金黄色葡萄球菌（CA-MRSA）完全取代。需要开展监测项目来追踪感染源和感染途径。我们利用分子诊断、抗菌谱分析和患者人口统计学数据，研究了哈伊勒医院中金黄色葡萄球菌的分布情况。从临床标本中分离出的274株金黄色葡萄球菌中，181株（66%，n = 181）为耐甲氧西林金黄色葡萄球菌，其中一些呈现HA-MRSA模式，对26种抗菌药物几乎完全耐药，对所有β-内酰胺类药物均耐药，而大多数对所有非β-内酰胺类药物高度敏感，表明为CA-MRSA类型。其余分离株（34%，n = 93）为甲氧西林敏感、青霉素耐药的甲氧西林敏感金黄色葡萄球菌谱系（90%）。耐甲氧西林金黄色葡萄球菌在男性中的比例在耐甲氧西林金黄色葡萄球菌总分离株（n = 181）中超过56%，在所有分离株（274株中的102株）中占37%，而甲氧西林敏感金黄色葡萄球菌在所有分离株中的比例为（17.5%，n = 48）。然而，在女性中，耐甲氧西林金黄色葡萄球菌和甲氧西林敏感金黄色葡萄球菌感染的比例分别为28.4%（n = 78）和12.4%（n = 34）。0 - 20岁、21 - 50岁和>50岁年龄组的耐甲氧西林金黄色葡萄球菌感染率分别为15%（n = 42）、17%（n = 48）和32%（n = 89）。然而，同一年龄组的甲氧西林敏感金黄色葡萄球菌感染率分别为13%（n = 35）、9%（n = 25）和8%（n = 22）。有趣的是，耐甲氧西林金黄色葡萄球菌感染率随年龄增长而增加，而甲氧西林敏感金黄色葡萄球菌感染率则随之下降，这意味着前者在生命早期占主导地位，随后逐渐被耐甲氧西林金黄色葡萄球菌取代。尽管已付出巨大努力，但耐甲氧西林金黄色葡萄球菌的主导地位和严重性可能与已知会增强毒力的β-内酰胺类药物使用增加有关。在原本健康的年轻人中CA-MRSA模式流行，而在老年人中被耐甲氧西林金黄色葡萄球菌取代，以及青霉素耐药的甲氧西林敏感金黄色葡萄球菌表型占主导地位，这意味着存在三种宿主和年龄特异性的进化谱系。因此，随着年龄增长甲氧西林敏感金黄色葡萄球菌感染率下降，同时老年人中耐甲氧西林金黄色葡萄球菌感染率增加并亚克隆分化为HA-MRSA，而年轻人和原本健康的患者中为CA-MRSA，这有力地支持了从常驻的青霉素耐药甲氧西林敏感金黄色葡萄球菌祖先发生亚克隆出现的观点。未来的纵向研究应侧重于监测侵袭性CA-MRSA的感染率和表型。
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