Abstract
IntroductionStaphylococcus aureus is a major cause of hospital infections worldwide. Awareness towards methicillin-resistant S. aureus (MRSA) infections is high but attention towards borderline oxacillin-resistant S. aureus (BORSA) is limited, possibly due to an underestimated clinical relevance, presumption of low incidence and diagnostic limitations.Gap statementBORSA surveillance has not been routinely implemented, and thus consensus with regard to a definition and infection control measures is lacking.AimOur goals were to investigate the occurrence, molecular characteristics and clinical manifestations of BORSA infections in the hospital setting.MethodologyFollowing an increased incidence in 2016, BORSA cases in 2014/2016 (in our institution) were more specifically evaluated. Medical records were reviewed to investigate epidemiological links, clinical characteristics and outcomes. Resistance and virulence markers were assessed by whole genome sequencing (WGS). Conventional methods: amplified fragment length polymorphism (AFLP) ; multilocus sequence typing (MLST) and multiple locus variable-number tandem repeat analysis (MLVA) were compared with core genome MLST (cgMLST) and whole-genome single nucleotide polymorphism (wgSNP) analysis to confirm genetic clusters.ResultsFrom 2009 to 2013, BORSA comprised 0.1 % of all clinical S. aureus strains. In 2016, the incidence was six-fold higher in comparison to the baseline. Whole-genome SNP and cgMLST confirmed two BORSA clusters among patients with dermatological conditions. Patients with BORSA presented with skin infections, and one case developed a severe invasive infection with a fatal outcome. Infection control measures successfully prevented further transmission in both clusters. WGS findings showed that BORSA strains carried multiple resistance and virulence genes with increased pathogenic potential.ConclusionWGS and cgMLST effectively characterized and confirmed BORSA clusters among at-risk patients with clinical manifestations ranging from mild skin infections to life-threatening bacteraemia. Clinical awareness and active monitoring are therefore warranted for the timely implementation of infection control measures to prevent BORSA transmission in high-risk patients.
Highlights
Staphylococcus aureus is a major cause of hospital infections worldwide
whole genome sequencing (WGS) and core genome MLST (cgMLST) effectively characterized and confirmed borderline oxacillin-resistant S. aureus (BORSA) clusters among at-r isk patients with clinical manifestations ranging from mild skin infections to life-threatening bacteraemia
Clinical awareness and active monitoring are warranted for the timely implementation of infection control measures to prevent BORSA transmission in high-r isk patients
Summary
Staphylococcus aureus is a major cause of hospital infections worldwide. Awareness towards methicillin-r esistant S. aureus (MRSA) infections is high but attention towards borderline oxacillin-resistant S. aureus (BORSA) is limited, possibly due to an underestimated clinical relevance, presumption of low incidence and diagnostic limitations.Gap statement. Staphylococcus aureus is a major cause of hospital infections worldwide. Staphylococcus aureus is a common bacterial pathogen that causes a wide range of community-a cquired and healthcare- associated infections. Β-Lactam antibiotics are the treatment of choice as most S. aureus are susceptible to penicillinase- resistant penicillins, including oxacillin and methicillin [1]. The increasing occurrence and transmission of methicillin-resistant S. aureus (MRSA) in hospital settings are of concern due their association with more difficult-to-t reat infections and increased mortality [2]. Vancomycin has a slower bactericidal rate against staphylococci and is inferior when compared to β-lactam treatment of severe S. aureus infections such as bacteraemia and endocarditis [8,9,10,11,12]
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