Department of General Intensive Care Unit, the Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, People's Republic of China.
State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China.
Emerg Microbes Infect. 2024 Dec;13(1):2316809. doi: 10.1080/22221751.2024.2316809. Epub 2024 Feb 21.
Previous studies have mainly focused on outpatient cases of skin and soft tissue infections (SSTIs), with limited attention to inpatient occurrences. Thus, we aimed to compare the clinical parameters of inpatients with SSTIs, performed genomic characterization, and determined the subtypes of Panton-Valentine leucocidin (PVL) bacteriophages of methicillin-resistant (MRSA) strains isolated from these patients. We found that PVL-positive patients had shorter hospital stays (mean, 9 vs. 24 days; < 0.001) and abscess resolution durations (mean, 8 vs. 13 days; < 0.01). PVL-positive MRSA-induced SSTIs were more frequently associated with abscesses [36/55 (65.5%) vs. 15/124 (12.1%), < 0.001], with 52.7% undergoing incision and drainage; over 80% of PVL-negative patients received incision, drainage, and antibiotics. In PVL-positive patients receiving empirical antibiotics, anti-staphylococcal agents such as vancomycin and linezolid were administered less frequently (32.7%, 18/55) than in PVL-negative patients (74.2%, 92/124), indicating that patients with PVL-positive SSTIs are more likely to require surgical drainage rather than antimicrobial treatment. We also found that the ST59 lineage was predominant, regardless of PVL status (41.3%, 74/179). Additionally, we investigated the linear structure of the gene, revealing that major clusters were associated with specific STs, suggesting independent acquisition of PVL by different strain types and indicating that significant diversity was observed even within PVL-positive strains detected in the same facility. Overall, our study provides comprehensive insights into the clinical, genetic, and phage-related aspects of MRSA-induced SSTIs in hospitalized patients and contributes to a more profound understanding of the epidemiology and evolution of these pathogens in the Chinese population.
先前的研究主要集中在门诊皮肤和软组织感染（SSTIs）病例，对住院患者的发病情况关注有限。因此，我们旨在比较住院 SSTIs 患者的临床参数，进行基因组特征分析，并确定这些患者分离的耐甲氧西林金黄色葡萄球菌（MRSA）菌株中潘顿-瓦伦丁溶细胞素（PVL）噬菌体的亚型。我们发现，PVL 阳性患者的住院时间（平均 9 天 vs. 24 天； < 0.001）和脓肿消退时间（平均 8 天 vs. 13 天； < 0.01）更短。PVL 阳性 MRSA 引起的 SSTIs 更常伴有脓肿[36/55（65.5%）比 15/124（12.1%）， < 0.001]，52.7%的患者进行切开引流；超过 80%的 PVL 阴性患者接受切开、引流和抗生素治疗。在接受经验性抗生素治疗的 PVL 阳性患者中，抗葡萄球菌药物如万古霉素和利奈唑胺的使用率较低（32.7%，18/55），低于 PVL 阴性患者（74.2%，92/124），这表明 PVL 阳性 SSTIs 患者更可能需要手术引流而不是抗菌治疗。我们还发现，无论 PVL 状态如何，ST59 谱系均占主导地位（41.3%，74/179）。此外，我们研究了基因的线性结构，发现主要簇与特定 ST 相关，表明不同的菌株类型独立获得了 PVL，这表明即使在同一医疗机构检测到的 PVL 阳性菌株中也观察到了显著的多样性。总体而言，本研究全面深入地了解了住院患者中 MRSA 引起的 SSTIs 的临床、遗传和噬菌体相关方面，有助于更深入地了解这些病原体在中国人群中的流行病学和进化。
