TY - JOUR
TI - Emergence of a staphylococcus aureus clone resistant to mupirocin and fusidic acid carrying exotoxin genes and causing mainly skin infections
AU - Doudoulakakis, A.
AU - Spiliopoulou, I.
AU - Spyridis, N.
AU - Giormezis, N.
AU - Kopsidas, J.
AU - Militsopoulou, M.
AU - Lebessi, E.
AU - Tsolia, M.
JO - Journal of Clinical Microbiology
PY - 2017
VL - 55
TODO - 8
SP - 2529-2537
PB - American Society for Microbiology
SN - 0095-1137, 1098-660X
TODO - 10.1128/JCM.00406-17
TODO - clindamycin;  fusidic acid;  pseudomonic acid;  antiinfective agent;  exotoxin;  fusidic acid;  pseudomonic acid, antibiotic resistance;  antibiotic sensitivity;  Article;  bacterial gene;  bacterial strain;  child;  controlled study;  ermA gene;  ermC gene;  eta gene;  etb gene;  female;  fnbA gene;  fusB gene;  gene sequence;  genetic association;  genotype;  human;  impetigo;  lukS gene;  major clinical study;  male;  methicillin susceptible Staphylococcus aureus;  molecular cloning;  multilocus sequence typing;  mupA gene;  nonhuman;  priority journal;  pulsed field gel electrophoresis;  retrospective study;  staphylococcal scalded skin syndrome;  adolescent;  classification;  community acquired infection;  drug effects;  genetics;  genotyping technique;  infant;  isolation and purification;  microbiology;  molecular epidemiology;  newborn;  polymerase chain reaction;  preschool child;  staphylococcal skin infection;  Staphylococcus aureus, Adolescent;  Anti-Bacterial Agents;  Child;  Child, Preschool;  Community-Acquired Infections;  Drug Resistance, Bacterial;  Electrophoresis, Gel, Pulsed-Field;  Exotoxins;  Female;  Fusidic Acid;  Genes, Bacterial;  Genotype;  Genotyping Techniques;  Humans;  Infant;  Infant, Newborn;  Male;  Molecular Epidemiology;  Multilocus Sequence Typing;  Mupirocin;  Polymerase Chain Reaction;  Retrospective Studies;  Staphylococcal Skin Infections;  Staphylococcus aureus
TODO - Skin and soft tissue infections (SSTIs) caused by mupirocin-resistant Staphylococcus aureus strains have recently increased in number in our settings. We sought to evaluate the characteristics of these cases over a 43-month period. Data for all community-acquired staphylococcal infections caused by mupirocin-resistant strains were retrospectively reviewed. Genes encoding products producing high-level resistance (HLR) to mupirocin (mupA), fusidic acid resistance (fusB), resistance to macrolides and lincosamides (ermC and ermA), Panton-Valentine leukocidin (PVL) (lukS/lukF-PV), exfoliative toxins (eta and etb), and fibronectin binding protein A (fnbA) were investigated by PCRs in 102 selected preserved strains. Genotyping was performed by SCCmec and agr typing, whereas clonality was determined by pulsedfield gel electrophoresis (PFGE) and multilocus sequence typing (MLST). A total of 437 cases among 2,137 staphylococcal infections were recorded in 2013 to 2016; they were all SSTIs with the exception of 1 case of primary bacteremia. Impetigo was the predominant clinical entity (371 cases [84.9%]), followed by staphylococcal scalded skin syndrome (21 cases [4.8%]), and there were no abscesses. The number of infections detected annually increased during the study years. All except 3 isolates were methicillin susceptible. The rates of HLR to mupirocin and constitutive resistance to clindamycin were 99% and 20.1%, respectively. Among the 102 tested strains, 100 (98%) were mupA positive and 97 (95%) were fusB positive, 26/27 clindamycin-resistant strains (96.3%) were ermA positive, 83 strains (81.4%) were lukS/lukF positive, 95 (93%) carried both eta and etb genes, and 99 (97%) were fnbA positive. Genotyping of methicillin-sensitive S. aureus (MSSA) strains revealed that 96/99 (96.7%) belonged to one main pulsotype, pulsotype 1, classified as sequence type 121 (ST121). The emergence of a single MSSA clone (ST121) causing impetigo was documented. Resistance to topical antimicrobials and a rich toxinogenic profile confer to this clone adaptability for spread in the community.
ER -