重塑战场：中国金黄色葡萄球菌十年克隆之战

Reshaping the battlefield: A decade of clonal wars among Staphylococcus aureus in China.

作者信息

Zhou Wangxiao, Jin Ye, Chen Pan, Ge Qi, Dong Xu, Chen Yunbo, Jiang Minghua, Xiao Yonghong

机构信息

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, China; Clinical Laboratory Center, The Second Affiliated Hospital & Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, 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, China; Department of General Intensive Care Unit, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.

出版信息

Drug Resist Updat. 2025 Jan;78:101178. doi: 10.1016/j.drup.2024.101178. Epub 2024 Nov 29.

DOI:10.1016/j.drup.2024.101178

PMID:39626615

Abstract

BACKGROUND

Long-term comprehensive studies on the genomic epidemiology of both methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-susceptible S. aureus (MSSA) isolates are limited in China. Here, we aimed to assess the genomic epidemiological characteristics and population dynamics of S. aureus in China.

METHODS

We performed whole-genome sequencing and resistance phenotyping on 3848 S. aureus isolates from bloodstream infections across 72 hospitals in 22 provinces, from 2011 to 2020 in China. We explored the dynamic trends in the resistance/virulence genes and mobile genetic element profiles across lineages, and conducted time-scaled phylogenetic investigation for prevalent lineages.

FINDINGS

The results revealed 315 different sequence types (STs) among all strains, 205 of which were novel. Significant shifts in MRSA population structure were observed, with ST59 replacing ST239 as the dominant lineage, exhibiting widespread inter-hospital transmission and increasing lineage diversity. In contrast, the composition of predominant MSSA lineages, ST188 (11.21 %), ST7 (9.79 %), ST22 (9.10 %), ST5 (8.56 %) and ST398 (7.91 %), remained relatively stable over time, with the diversity among MSSA strains consistently preserved at the population level. Phylogenetic reconstruction showed that ST59, ST398, ST22 and ST188 MSSA could evolve into corresponding MRSA lineages through the acquisition of staphylococcal cassette chromosome mec (SCCmec) elements. Moreover, the distribution patterns of resistance and virulence genes closely correlated with different lineages, where the proportion of PVL isolates in MRSA is rising. Concurrently, changes in the MRSA population structure led to an overall decrease in the number of resistance and virulence genes, significantly increased antimicrobial sensitivity.

INTERPRETATION

The shifting genomic landscape of S. aureus in China underscores the need for tailored antimicrobial stewardship and enhances understanding of its epidemiological trends over the past decade.

摘要

背景

在中国，针对耐甲氧西林金黄色葡萄球菌（MRSA）和甲氧西林敏感金黄色葡萄球菌（MSSA）分离株的基因组流行病学的长期综合研究有限。在此，我们旨在评估中国金黄色葡萄球菌的基因组流行病学特征和群体动态。

方法

我们对2011年至2020年期间来自中国22个省份72家医院血流感染的3848株金黄色葡萄球菌分离株进行了全基因组测序和耐药表型分析。我们探究了不同谱系中耐药/毒力基因和移动遗传元件图谱的动态趋势，并对流行谱系进行了时间尺度的系统发育研究。

研究结果

结果显示所有菌株中共有315种不同的序列类型（STs），其中205种为新发现的。观察到MRSA群体结构发生了显著变化，ST59取代ST239成为主要谱系，呈现出广泛的医院间传播且谱系多样性增加。相比之下，主要MSSA谱系ST188（11.21%）、ST7（9.79%）、ST22（9.10%）、ST5（8.56%）和ST398（7.91%）的组成随时间保持相对稳定，MSSA菌株间的多样性在群体水平上持续保持。系统发育重建表明，ST59、ST398、ST22和ST188 MSSA可通过获得葡萄球菌盒式染色体mec（SCCmec）元件演变为相应的MRSA谱系。此外，耐药和毒力基因的分布模式与不同谱系密切相关，其中MRSA中Panton-Valentine杀白细胞素（PVL）分离株的比例正在上升。同时，MRSA群体结构的变化导致耐药和毒力基因数量总体减少，抗菌敏感性显著提高。