Abstract
ABSTRACT A consistently decreasing prevalence of MRSA infections in China has been reported, however, the underlying mechanism of molecular processes responsible for this decline in MRSA infections has been poorly understood. We conducted an epidemiologic investigation to determine the dynamic changes of Staphylococcus aureus infections. A total of 3695 S. aureus isolates was recovered from 2008 to 2017, and subsequently characterized by infection types, resistance profile, and clone types. The frequency of respiratory infection decreased over the study period from 76% to 52%. The proportion of MRSA remarkably decreased (from 83.5% to 54.2%, 2008-2017) (p < .0001). The prevalence of predominant healthcare-associated MRSA (HA-MRSA) clones, ST239-t030 and ST239-t037, significantly decreased (from 20.3% to 1% and 18.4% to 0.5%, 2008-2017, respectively); both of them were replaced by the continually growing ST5-t2460 clone (from 0% to 17.3%, 2008-2017). Epidemic community-acquired MRSA (CA-MRSA) ST59 and ST398 clones also increased (from 1.0% to 5.8% and 1.8% to 10.5%, 2008-2017, respectively). These results demonstrated a significant decrease in the previously dominant HA-MRSA ST239 clones, leading to a marked decrease in the prevalence of MRSA over the past decade, and shed new light on the complex competition of S. aureus clones predominating within the health-care environment.
Highlights
Epidemic community-acquired MRSA (CA-MRSA) ST59 and ST398 clones increased. These results demonstrated a significant decrease in the previously dominant healthcare-associated MRSA (HA-MRSA) ST239 clones, leading to a marked decrease in the prevalence of MRSA over the past decade, and shed new light on the complex competition of S. aureus clones predominating within the health-care environment
While numerous studies have reported epidemiological changes in HA-MRSA [10], few studies have focused on the changing epidemiology of both MRSA and methicillin-sensitive S. aureus (MSSA) isolates over a long period of time in China, despite the fact that MSSA isolates provide a pool of organisms for the emergence of new MRSA clones, and are of essence for controlling the potential emergence of new epidemic MRSA clones [11]
A total of 3695 consecutive and non-repetitive S. aureus isolates was collected between 2008 and 2017 from inpatients, most of whom were aged over 20 years old (Table 1)
Summary
It is vital to investigate the changing epidemiology of S. aureus infection over a long period for the purpose of guiding new control initiatives, providing keen insights into its evolutionary process, and containing its spread. While numerous studies have reported epidemiological changes in HA-MRSA [10], few studies have focused on the changing epidemiology of both MRSA and methicillin-sensitive S. aureus (MSSA) isolates over a long period of time in China, despite the fact that MSSA isolates provide a pool of organisms for the emergence of new MRSA clones, and are of essence for controlling the potential emergence of new epidemic MRSA clones [11]. The present study retrospectively characterized S. aureus isolates involved in hospital-onset infection over the past decade in a tertiary care hospital, one of the largest comprehensive hospitals in Shanghai, and aimed at investigating the changes in the molecular characteristics of both MRSA and MSSA, as well as the pattern of infection type and antibiotic resistance profile
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