Abstract
BackgroundStaphylococcus aureus causes various infections, including skin and soft tissue infections (SSTIs). In this study, methicillin-susceptible S. aureus (MSSA) from SSTIs among patients in three tertiary-care hospitals in Greece were studied in terms of antimicrobial resistance, clonal distribution, toxin and adhesin genes carriage.ResultsDuring a five-year period (2014–2018), 6145 S. aureus were recovered from 13,244 patients with SSTIs and tested for antimicrobial susceptibility. MSSA were 4806 (78.21 %) including 1484 isolates with mupirocin minimum inhibitory concentration (MIC) > 64 mg/L (30.88 %). Two hundred and sixty representative mupirocin-resistant MSSA were analyzed for genes encoding Panton-Valentine leukocidin (PVL, lukS/lukF-PV), exfoliative toxins (eta, etb), adhesin FnbA (fnbA) and resistance genes mupA (high-level resistance to mupirocin), fusB (fusidic acid), aminoglycosides’ modifying enzymes, ermA, ermC and msrA (macrolides/lincosamides) by PCRs. Strains were classified into clones by PFGE and MLST.All mupirocin-resistant MSSA were penicillin-resistant; 92.7 % expressed resistance to fusidic acid and 88.9 % to tobramycin. All 260 molecularly analyzed isolates were mupA-positive; all fusidic acid-resistant (241/260) carried fusB whereas, the tobramycin-resistant ones (230), ant(4′)-Ia. The majority carried eta (93.85 %), etb (98.08 %) and fnbA (88.85 %). PFGE typing revealed a mostly unvarying population; 260 MSSA were grouped into three types. One major eta/etb-positive clone comprising of 258/260 strains (99.2 %), PFGE type 1, was classified as ST121, including nine strains co-carrying PVL. Another PVL-positive strain was identified as ST1, and one toxins-negative as ST21.ConclusionsA mupirocin-resistant MSSA clone, ST121, carrying resistance, exfoliative toxins and adhesin genes, was spread and predominated in SSTIs from patients in Greece during the five-year studied period.
Highlights
Staphylococcus aureus causes various infections, including skin and soft tissue infections (SSTIs)
An increase of methicillin-susceptible S. aureus (MSSA) among S. aureus causing SSTIs was observed during the fiveyear period, from 66.67 % to 2014 to 88.15 % in 2018 (Fig. 2)
One third of MSSA, 1484/4806 (30.88 %), associated with SSTIs showed mupirocin minimum inhibitory concentration (MIC) ranging from 64 mg/L to > 1024 mg/L
Summary
Staphylococcus aureus causes various infections, including skin and soft tissue infections (SSTIs). Despite being part of the human flora, staphylococci can cause a wide range of infections, including skin and soft tissue infections (SSTIs), pneumonia and bacteraemia [2]. The S. aureus fibronectin-binding protein A (FnbA), encoded by fnbA gene, possesses multiple regions capable of conferring adherence to both soluble and immobilized forms of fibronectin [4]. This confers S. aureus the ability to invade endothelial cells in vivo and in vitro. FnbA promotes bacterial attachment to fibrinogen as well as, adherence and aggregation of activated platelets [5]. Several studies have demonstrated the prevalence of FnbA against the homologous protein FnbB [6, 7]
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