Healthcare- and community-associated methicillin-resistant Staphylococcus aureus (MRSA) and fatal pneumonia with pediatric deaths in Krasnoyarsk, Siberian Russia: Unique MRSA's multiple virulence factors, genome, and stepwise evolution
Journal
PLoS ONE
Journal Volume
10
Journal Issue
6
Pages
e0128017
Date Issued
2015
Author(s)
Khokhlova O.E.
Hung W.-C.
Wan T.-W.
Iwao Y.
Takano T.
Higuchi W.
Yachenko S.V.
Teplyakova O.V.
Kamshilova V.V.
Kotlovsky Y.V.
Nishiyama A.
Reva I.V.
Sidorenko S.V.
Peryanova O.V.
Reva G.V.
Salmina A.B.
Yamamoto T.
Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) is a common multidrug-resistant (MDR) pathogen. We herein discussed MRSA and its infections in Krasnoyarsk, Siberian Russia between 2007 and 2011. The incidence of MRSA in 3,662 subjects was 22.0% and 2.9% for healthcare- and community-associated MRSA (HA- and CA-MRSA), respectively. The 15-day mortality rates for MRSA hospital- and community-acquired pneumonia (HAP and CAP) were 6.5% and 50%, respectively. MRSA CAP cases included pediatric deaths; of the MRSA pneumonia episodes available, ?27.3% were associated with bacteremia. Most cases of HA-MRSA examined exhibited ST239/spa3(t037)/SCCmecIII.1.1.2 (designated as ST239Kras), while all CA-MRSA cases examined were ST8/spa1(t008)/SCCmecIV.3.1.1(IVc) (designated as ST8Kras). ST239Kras and ST8Kras strongly expressed cytolytic peptide (phenol-soluble modulin α, PSMα; and δ-hemolysin, Hld) genes, similar to CA-MRSA. ST239Kras pneumonia may have been attributed to a unique set of multiple virulence factors (MVFs): toxic shock syndrome toxin-1 (TSST-1), elevated PSMα/Hld expression, α-hemolysin, the staphylococcal enterotoxin SEK/SEQ, the immune evasion factor SCIN/ SAK, and collagen adhesin. Regarding ST8Kras, SEA was included in MVFs, some of which were common to ST239Kras. The ST239Kras (strain OC3) genome contained: a completely unique phage, φSa7-like (W), with no att repetition; S. aureus pathogenicity island SaPI2R, the first TSST-1 gene-positive (tst+) SaPI in the ST239 lineage; and a super copy of IS256 (?22 copies/genome). ST239Kras carried the Brazilian SCCmecIII.1.1.2 and United Kingdom-type tst. ST239Kras and ST8Kras were MDR, with the same levofloxacin resistance mutations; small, but transmissible chloramphenicol resistance plasmids spread widely enough to not be ignored. These results suggest that novel MDR and MVF+ HA- and CA-MRSA (ST239Kras and ST8Kras) emerged in Siberian Russia (Krasnoyarsk) associated with fatal pneumonia, and also with ST239Kras, a new (Siberian Russian) clade of the ST239 lineage, which was created through stepwise evolution during its potential transmission route of Brazil-Europe-Russia/Krasnoyarsk, thereby selective advantages from unique MVFs and the MDR. ? 2015 Khokhlova et al.
SDGs
Other Subjects
bacterial protein; protein SEK; protein SEQ; SCIN protein; Staphylococcus enterotoxin; toxic shock syndrome toxin 1; unclassified drug; bacterial DNA; bacterial protein; virulence factor; adolescent; adult; aged; Article; bacteremia; bacterial gene; bacterial genome; bacterial mutation; bacterial virulence; child; community acquired pneumonia; controlled study; delta hemolysin gene; female; genetic variability; health care associated pneumonia; human; infant; major clinical study; male; methicillin resistant Staphylococcus aureus; methicillin resistant Staphylococcus aureus infection; middle aged; mortality; nonhuman; pathogenicity island; phenol soluble modulin alpha gene; plasmid; preschool child; Russian Federation; staphylococcal pneumonia; very elderly; young adult; analysis; community acquired infection; follow up; genetics; genotype; isolation and purification; metabolism; microbiology; molecular evolution; multidrug resistance; newborn; pathology; pneumonia; retrospective study; Staphylococcus infection; survival analysis; methicillin resistant Staphylococcus aureus; Staphylococcus aureus; Adolescent; Adult; Aged; Aged, 80 and over; Bacterial Proteins; Child; Child, Preschool; Community-Acquired Infections; DNA, Bacterial; Drug Resistance, Multiple, Bacterial; Evolution, Molecular; Female; Follow-Up Studies; Genome, Bacterial; Genotype; Humans; Infant; Infant, Newborn; Male; Methicillin-Resistant Staphylococcus aureus; Middle Aged; Plasmids; Pneumonia; Retrospective Studies; Russia; Staphylococcal Infections; Survival Analysis; Virulence Factors; Young Adult
Type
journal article