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Next-Generation Sequence Analysis Reveals Transfer of Methicillin Resistance to a Methicillin-Susceptible Staphylococcus aureus Strain That Subsequently Caused a Methicillin-Resistant Staphylococcus aureus Outbreak: a Descriptive Study.
J Clin Microbiol. 2017 09; 55(9):2808-2816.JC

Abstract

Resistance to methicillin in Staphylococcus aureus is caused primarily by the mecA gene, which is carried on a mobile genetic element, the staphylococcal cassette chromosome mec (SCCmec). Horizontal transfer of this element is supposed to be an important factor in the emergence of new clones of methicillin-resistant Staphylococcus aureus (MRSA) but has been rarely observed in real time. In 2012, an outbreak occurred involving a health care worker (HCW) and three patients, all carrying a fusidic acid-resistant MRSA strain. The husband of the HCW was screened for MRSA carriage, but only a methicillin-susceptible S. aureus (MSSA) strain, which was also resistant to fusidic acid, was detected. Multiple-locus variable-number tandem-repeat analysis (MLVA) typing showed that both the MSSA and MRSA isolates were MT4053-MC0005. This finding led to the hypothesis that the MSSA strain acquired the SCCmec and subsequently caused an outbreak. To support this hypothesis, next-generation sequencing of the MSSA and MRSA isolates was performed. This study showed that the MSSA isolate clustered closely with the outbreak isolates based on whole-genome multilocus sequence typing and single-nucleotide polymorphism (SNP) analysis, with a genetic distance of 17 genes and 44 SNPs, respectively. Remarkably, there were relatively large differences in the mobile genetic elements in strains within and between individuals. The limited genetic distance between the MSSA and MRSA isolates in combination with a clear epidemiologic link supports the hypothesis that the MSSA isolate acquired a SCCmec and that the resulting MRSA strain caused an outbreak.

Authors+Show Affiliations

Laboratory for Microbiology and Infection Control, Amphia Hospital, Breda, The Netherlands vweterings@amphia.nl. Medical Microbiology, Radboud University Medical Centre, Nijmegen, The Netherlands.National Institute for Public Health and the Environment, Bilthoven, The Netherlands.National Institute for Public Health and the Environment, Bilthoven, The Netherlands.National Institute for Public Health and the Environment, Bilthoven, The Netherlands.National Institute for Public Health and the Environment, Bilthoven, The Netherlands.Laboratory for Microbiology and Infection Control, Amphia Hospital, Breda, The Netherlands. Julius Center for Health Sciences and Primary Care, UMC Utrecht, Utrecht, The Netherlands.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

28679522

Citation

Weterings, Veronica, et al. "Next-Generation Sequence Analysis Reveals Transfer of Methicillin Resistance to a Methicillin-Susceptible Staphylococcus Aureus Strain That Subsequently Caused a Methicillin-Resistant Staphylococcus Aureus Outbreak: a Descriptive Study." Journal of Clinical Microbiology, vol. 55, no. 9, 2017, pp. 2808-2816.
Weterings V, Bosch T, Witteveen S, et al. Next-Generation Sequence Analysis Reveals Transfer of Methicillin Resistance to a Methicillin-Susceptible Staphylococcus aureus Strain That Subsequently Caused a Methicillin-Resistant Staphylococcus aureus Outbreak: a Descriptive Study. J Clin Microbiol. 2017;55(9):2808-2816.
Weterings, V., Bosch, T., Witteveen, S., Landman, F., Schouls, L., & Kluytmans, J. (2017). Next-Generation Sequence Analysis Reveals Transfer of Methicillin Resistance to a Methicillin-Susceptible Staphylococcus aureus Strain That Subsequently Caused a Methicillin-Resistant Staphylococcus aureus Outbreak: a Descriptive Study. Journal of Clinical Microbiology, 55(9), 2808-2816. https://doi.org/10.1128/JCM.00459-17
Weterings V, et al. Next-Generation Sequence Analysis Reveals Transfer of Methicillin Resistance to a Methicillin-Susceptible Staphylococcus Aureus Strain That Subsequently Caused a Methicillin-Resistant Staphylococcus Aureus Outbreak: a Descriptive Study. J Clin Microbiol. 2017;55(9):2808-2816. PubMed PMID: 28679522.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Next-Generation Sequence Analysis Reveals Transfer of Methicillin Resistance to a Methicillin-Susceptible Staphylococcus aureus Strain That Subsequently Caused a Methicillin-Resistant Staphylococcus aureus Outbreak: a Descriptive Study. AU - Weterings,Veronica, AU - Bosch,Thijs, AU - Witteveen,Sandra, AU - Landman,Fabian, AU - Schouls,Leo, AU - Kluytmans,Jan, Y1 - 2017/07/05/ PY - 2017/03/19/received PY - 2017/06/29/accepted PY - 2017/7/7/pubmed PY - 2018/4/19/medline PY - 2017/7/7/entrez KW - MRSA KW - MSSA KW - NGS KW - SCCmec KW - Staphylococcus aureus KW - mecA KW - methicillin resistance KW - next-generation sequencing KW - outbreak KW - staphylococcal cassette chromosome mec KW - wgMLST KW - within-host diversity SP - 2808 EP - 2816 JF - Journal of clinical microbiology JO - J Clin Microbiol VL - 55 IS - 9 N2 - Resistance to methicillin in Staphylococcus aureus is caused primarily by the mecA gene, which is carried on a mobile genetic element, the staphylococcal cassette chromosome mec (SCCmec). Horizontal transfer of this element is supposed to be an important factor in the emergence of new clones of methicillin-resistant Staphylococcus aureus (MRSA) but has been rarely observed in real time. In 2012, an outbreak occurred involving a health care worker (HCW) and three patients, all carrying a fusidic acid-resistant MRSA strain. The husband of the HCW was screened for MRSA carriage, but only a methicillin-susceptible S. aureus (MSSA) strain, which was also resistant to fusidic acid, was detected. Multiple-locus variable-number tandem-repeat analysis (MLVA) typing showed that both the MSSA and MRSA isolates were MT4053-MC0005. This finding led to the hypothesis that the MSSA strain acquired the SCCmec and subsequently caused an outbreak. To support this hypothesis, next-generation sequencing of the MSSA and MRSA isolates was performed. This study showed that the MSSA isolate clustered closely with the outbreak isolates based on whole-genome multilocus sequence typing and single-nucleotide polymorphism (SNP) analysis, with a genetic distance of 17 genes and 44 SNPs, respectively. Remarkably, there were relatively large differences in the mobile genetic elements in strains within and between individuals. The limited genetic distance between the MSSA and MRSA isolates in combination with a clear epidemiologic link supports the hypothesis that the MSSA isolate acquired a SCCmec and that the resulting MRSA strain caused an outbreak. SN - 1098-660X UR - https://www.unboundmedicine.com/medline/citation/28679522/Next_Generation_Sequence_Analysis_Reveals_Transfer_of_Methicillin_Resistance_to_a_Methicillin_Susceptible_Staphylococcus_aureus_Strain_That_Subsequently_Caused_a_Methicillin_Resistant_Staphylococcus_aureus_Outbreak:_a_Descriptive_Study_ L2 - http://jcm.asm.org/cgi/pmidlookup?view=long&pmid=28679522 DB - PRIME DP - Unbound Medicine ER -