Entry of Panton\u2013Valentine leukocidin-positive methicillin-resistant Staphylococcus aureus into the hospital: prevalence and population structure in Heidelberg, Germany 2015\u20132018

Sabrina Klein,Sébastien Boutin,Dennis Nurjadi,Philipp Zanger,Julius Hannesen,Klaus Heeg

doi:10.1038/s41598-020-70112-z

Sabrina Klein, Sébastien Boutin + Show 4 more

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https://doi.org/10.1038/s41598-020-70112-z

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Abstract

Staphylococcus aureus is one of the major pathogens causing community—and healthcare-acquired infections. The presence of the virulence factor Panton–Valentine leukocidin (PVL) is associated with recurrent infection and clinical severity and generally regarded as a feature of community associated-methicillin-resistant Staphylococcus aureus (MRSA). To date, the focus of PVL-positive MRSA in hospitalized patients has been on outbreaks. We aimed to investigate whether PVL-positive MRSA has penetrated the community-hospital barrier by determining the prevalence of PVL in MRSA of hospitalized patients. MRSA strains isolated from patients hospitalized > 48 h in Heidelberg University Hospital between 2015 and 2018 Isolates were analysed for the presence of PVL and subjected to spa-typing. PVL-positive MRSA were then characterized by whole genome sequencing. We analysed 740 MRSA isolates in the study period and identified 6.2% (n = 46) PVL-positivity. 32.6% of PVL-positive MRSA met the criteria for nosocomial acquisition. The most frequent clones among the PVL-positive strains were ST80-t044 (21.7%, n = 10/46) and ST8-t008 (19.5%, n = 9/46). WGS identified three possible transmission clusters involving seven patients. In conclusion, we found successful epidemic PVL-positive MRSA clones entering the hospital and causing nosocomial infections. Preventive measures and constant surveillance should be maintained to prevent transmissions and clonal outbreaks.

Highlights

Staphylococcus aureus is one of the major causes of community and hospital acquired infections
Panton–Valentine leukocidin (PVL) is associated with the severity of infection[3], the characterization of methicillin-resistant S. aureus (MRSA) isolates in hospitalized patients in Germany in terms of PVL is not pursued
We found that the clonal distribution as determined by MLST and spa-typing was overall concordant with existing knowledge about the molecular epidemiology of MRSA in Germany: 30.5% of isolates were spa-type t003, consistent with the predominant ST5 “Rhine-Hesse epidemic clone”[14] and 5.8% t0028

Summary

Introduction

Staphylococcus aureus is one of the major causes of community and hospital acquired infections. The overall prevalence of methicillin-resistant S. aureus (MRSA) in Germany is d eclining[1], MRSA strains harboring the pathogenic marker Panton–Valentine leukocidin (PVL) are isolated more frequently[2]. The overall prevalence of PVL in Germany is considered low according to data acquired by Schaumburg et al.[8], a study by Jappe et al.[9] revealed. Our recent study suggests an alarmingly high prevalence of PVL positivity (40%) in community onset (CO)-MRSA causing skin and soft-tissue infections (SSTI) in South West Germany between 2012 and 20162. Systematic data on the prevalence and molecular characteristics of PVL-bearing MRSA in hospitalized patients in Germany is scarce. Surveillance data and other published report suggest that a high percentage of imported epidemic MRSA clones are circulating and causing community acquired infections[2,3,4]. Clonal shift of MRSA population in the healthcare setting should be monitored closely to prevent clonal spread of highly virulent and epidemic MRSA clones

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