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Hinz A, Amado A, Kassen R, Bank C, Wong A. Unpredictability of the Fitness Effects of Antimicrobial Resistance Mutations Across Environments in Escherichia coli. Mol Biol Evol 2024; 41:msae086. [PMID: 38709811 PMCID: PMC11110942 DOI: 10.1093/molbev/msae086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 04/11/2024] [Accepted: 04/30/2024] [Indexed: 05/08/2024] Open
Abstract
The evolution of antimicrobial resistance (AMR) in bacteria is a major public health concern, and antibiotic restriction is often implemented to reduce the spread of resistance. These measures rely on the existence of deleterious fitness effects (i.e. costs) imposed by AMR mutations during growth in the absence of antibiotics. According to this assumption, resistant strains will be outcompeted by susceptible strains that do not pay the cost during the period of restriction. The fitness effects of AMR mutations are generally studied in laboratory reference strains grown in standard growth environments; however, the genetic and environmental context can influence the magnitude and direction of a mutation's fitness effects. In this study, we measure how three sources of variation impact the fitness effects of Escherichia coli AMR mutations: the type of resistance mutation, the genetic background of the host, and the growth environment. We demonstrate that while AMR mutations are generally costly in antibiotic-free environments, their fitness effects vary widely and depend on complex interactions between the mutation, genetic background, and environment. We test the ability of the Rough Mount Fuji fitness landscape model to reproduce the empirical data in simulation. We identify model parameters that reasonably capture the variation in fitness effects due to genetic variation. However, the model fails to accommodate the observed variation when considering multiple growth environments. Overall, this study reveals a wealth of variation in the fitness effects of resistance mutations owing to genetic background and environmental conditions, which will ultimately impact their persistence in natural populations.
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Affiliation(s)
- Aaron Hinz
- Department of Biology, Carleton University, Ottawa, ON K1S 5B6, Canada
- Department of Biology, University of Ottawa, Ottawa, ON K1N 6N5, Canada
- Department of Biology, McGill University, Montreal, QC H3A 1B1, Canada
| | - André Amado
- Institute of Ecology and Evolution, University of Bern, Bern, Switzerland
- Division of Theoretical Ecology and Evolution, Swiss Institute of Bioinformatics, Lausanne, Switzerland
- Evolutionary Dynamics Group, Gulbenkian Science Institute, Oeiras, Portugal
| | - Rees Kassen
- Department of Biology, University of Ottawa, Ottawa, ON K1N 6N5, Canada
- Department of Biology, McGill University, Montreal, QC H3A 1B1, Canada
| | - Claudia Bank
- Institute of Ecology and Evolution, University of Bern, Bern, Switzerland
- Division of Theoretical Ecology and Evolution, Swiss Institute of Bioinformatics, Lausanne, Switzerland
- Evolutionary Dynamics Group, Gulbenkian Science Institute, Oeiras, Portugal
| | - Alex Wong
- Department of Biology, Carleton University, Ottawa, ON K1S 5B6, Canada
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Cuny C, Layer-Nicolaou F, Werner G, Witte W. A look at staphylococci from the one health perspective. Int J Med Microbiol 2024; 314:151604. [PMID: 38367509 DOI: 10.1016/j.ijmm.2024.151604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 01/11/2024] [Accepted: 01/15/2024] [Indexed: 02/19/2024] Open
Abstract
Staphylococcus aureus and other staphylococcal species are resident and transient multihost colonizers as well as conditional pathogens. Especially S. aureus represents an excellent model bacterium for the "One Health" concept because of its dynamics at the human-animal interface and versatility with respect to host adaptation. The development of antimicrobial resistance plays another integral part. This overview will focus on studies at the human-animal interface with respect to livestock farming and to companion animals, as well as on staphylococci in wildlife. In this context transmissions of staphylococci and of antimicrobial resistance genes between animals and humans are of particular significance.
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Affiliation(s)
- Christiane Cuny
- Division of Nosocomial Pathogens and Antibiotic Resistances, Department of Infectious Diseases, Robert Koch Institute, National Reference Centre for Staphylococci and Enterococci, Wernigerode Branch, 38855 Wernigerode, Germany.
| | - Franziska Layer-Nicolaou
- Division of Nosocomial Pathogens and Antibiotic Resistances, Department of Infectious Diseases, Robert Koch Institute, National Reference Centre for Staphylococci and Enterococci, Wernigerode Branch, 38855 Wernigerode, Germany
| | - Guido Werner
- Division of Nosocomial Pathogens and Antibiotic Resistances, Department of Infectious Diseases, Robert Koch Institute, National Reference Centre for Staphylococci and Enterococci, Wernigerode Branch, 38855 Wernigerode, Germany
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Zheng L, Jiang Z, Wang Z, Li Y, Jiao X, Li Q, Tang Y. The prevalence of Staphylococcus aureus and the emergence of livestock-associated MRSA CC398 in pig production in eastern China. Front Microbiol 2023; 14:1267885. [PMID: 38163065 PMCID: PMC10755019 DOI: 10.3389/fmicb.2023.1267885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 12/07/2023] [Indexed: 01/03/2024] Open
Abstract
Livestock-associated Staphylococcus aureus (LA-MRSA) has been of increasing concern due to its potential risk to humans. This study investigated the prevalence of MRSA in pig production in Eastern China and determined the genomic characteristics of pig-associated MRSA isolates by whole-genome sequencing (WGS). A total of 1,318 samples were collected from pig farms and pig slaughterhouses, and 150 S. aureus were identified, including 63 MRSA isolates and 87 MSSA isolates. MRSA was detected in all pig farms and pig slaughterhouses. The antimicrobial susceptibility test revealed that all MRSA isolates were multidrug-resistant. The WGS and MLST analysis demonstrated that 56 MRSA isolates belonged to clonal complex (CC) 398, and seven MRSA isolates belonged to CC9. All LA-MRSA isolates were absent of phiSa3 phage containing immune evasion cluster (IEC) and possessed an intact hlb gene. In addition, genes associated with Panton-Valentine leukocidin, typically indicative of human adaptation, were not detected. The analysis of antibiotic resistance genes (ARGs) demonstrated that all MRSA isolates contained multiple ARGs. All MRSA isolates had Plthe mecA gene and at least one tetracycline resistance gene. Both tetM and tetK were detected in all MRSA CC398 isolates, while tetL was detected in all MRSA CC9 isolates. The phenicol resistance gene fexA was detected in 51 MRSA isolates, while the linezolid resistance gene cfr was detected in 60 MRSA isolates. The emergence of LA-MRSA CC398 in four pig farms and one slaughterhouse in this study indicates the spread of this clonal complex in the pig production sector in Eastern China. Further investigations are required to understand the potential transmission routes of LA-MRSA CC398 within the pork production chain in China and to assess the potential risks to humans.
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Affiliation(s)
- Lina Zheng
- College of Bioscience and Biotechnology, Yangzhou University, Yangzhou, Jiangsu, China
| | - Zhongyi Jiang
- Jiangsu Key Laboratory of Zoonosis/Jiangsu Co-Innovation Center for Prevention and Control of Important Animal Infectious Diseases and Zoonoses, Yangzhou University, Yangzhou, Jiangsu, China
- Key Laboratory of Prevention and Control of Biological Hazard Factors (Animal Origin) for Agri-food Safety and Quality, Ministry of Agriculture of China, Yangzhou University, Yangzhou, Jiangsu, China
| | - Zhenyu Wang
- Jiangsu Key Laboratory of Zoonosis/Jiangsu Co-Innovation Center for Prevention and Control of Important Animal Infectious Diseases and Zoonoses, Yangzhou University, Yangzhou, Jiangsu, China
- Key Laboratory of Prevention and Control of Biological Hazard Factors (Animal Origin) for Agri-food Safety and Quality, Ministry of Agriculture of China, Yangzhou University, Yangzhou, Jiangsu, China
| | - Yang Li
- Jiangsu Key Laboratory of Zoonosis/Jiangsu Co-Innovation Center for Prevention and Control of Important Animal Infectious Diseases and Zoonoses, Yangzhou University, Yangzhou, Jiangsu, China
- Key Laboratory of Prevention and Control of Biological Hazard Factors (Animal Origin) for Agri-food Safety and Quality, Ministry of Agriculture of China, Yangzhou University, Yangzhou, Jiangsu, China
| | - Xinan Jiao
- Jiangsu Key Laboratory of Zoonosis/Jiangsu Co-Innovation Center for Prevention and Control of Important Animal Infectious Diseases and Zoonoses, Yangzhou University, Yangzhou, Jiangsu, China
- Key Laboratory of Prevention and Control of Biological Hazard Factors (Animal Origin) for Agri-food Safety and Quality, Ministry of Agriculture of China, Yangzhou University, Yangzhou, Jiangsu, China
- Joint International Research Laboratory of Agriculture and Agri-Product Safety, Yangzhou University, Yangzhou, Jiangsu, China
| | - Qiuchun Li
- College of Bioscience and Biotechnology, Yangzhou University, Yangzhou, Jiangsu, China
- Jiangsu Key Laboratory of Zoonosis/Jiangsu Co-Innovation Center for Prevention and Control of Important Animal Infectious Diseases and Zoonoses, Yangzhou University, Yangzhou, Jiangsu, China
- Key Laboratory of Prevention and Control of Biological Hazard Factors (Animal Origin) for Agri-food Safety and Quality, Ministry of Agriculture of China, Yangzhou University, Yangzhou, Jiangsu, China
- Joint International Research Laboratory of Agriculture and Agri-Product Safety, Yangzhou University, Yangzhou, Jiangsu, China
| | - Yuanyue Tang
- College of Bioscience and Biotechnology, Yangzhou University, Yangzhou, Jiangsu, China
- Jiangsu Key Laboratory of Zoonosis/Jiangsu Co-Innovation Center for Prevention and Control of Important Animal Infectious Diseases and Zoonoses, Yangzhou University, Yangzhou, Jiangsu, China
- Key Laboratory of Prevention and Control of Biological Hazard Factors (Animal Origin) for Agri-food Safety and Quality, Ministry of Agriculture of China, Yangzhou University, Yangzhou, Jiangsu, China
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Rittscher AE, Vlasblom AA, Duim B, Scherpenisse P, van Schothorst IJ, Wouters IM, Van Gompel L, Smit LAM. A comparison of passive and active dust sampling methods for measuring airborne methicillin-resistant Staphylococcus aureus in pig farms. Ann Work Expo Health 2023; 67:1004-1010. [PMID: 37300560 PMCID: PMC10516621 DOI: 10.1093/annweh/wxad033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 05/24/2023] [Indexed: 06/12/2023] Open
Abstract
Methicillin-resistant strains of Staphylococcus aureus (MRSA) are resistant to most β-lactam antibiotics. Pigs are an important reservoir of livestock-associated MRSA (LA-MRSA), which is genetically distinct from both hospital and community-acquired MRSA. Occupational exposure to pigs on farms can lead to LA-MRSA carriage by workers. There is a growing body of research on MRSA found in the farm environment, the airborne route of transmission, and its implication on human health. This study aims to directly compare two sampling methods used to measure airborne MRSA in the farm environment; passive dust sampling with electrostatic dust fall collectors (EDCs), and active inhalable dust sampling using stationary air pumps with Gesamtstaubprobenahme (GSP) sampling heads containing Teflon filters. Paired dust samples using EDCs and GSP samplers, totaling 87 samples, were taken from 7 Dutch pig farms, in multiple compartments housing pigs of varying ages. Total nucleic acids of both types of dust samples were extracted and targets indicating MRSA (femA, nuc, mecA) and total bacterial count (16S rRNA) were quantified using quantitative real-time PCRs. MRSA could be measured from all GSP samples and in 94% of the EDCs, additionally MRSA was present on every farm sampled. There was a strong positive relationship between the paired MRSA levels found in EDCs and those measured on filters (Normalized by 16S rRNA; Pearson's correlation coefficient r = 0.94, Not Normalized; Pearson's correlation coefficient r = 0.84). This study suggests that EDCs can be used as an affordable and easily standardized method for quantifying airborne MRSA levels in the pig farm setting.
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Affiliation(s)
- Anne E Rittscher
- Institute for Risk Assessment Sciences (IRAS), Faculty of Veterinary Medicine, Utrecht University, Yalelaan 2, 3584 CM Utrecht, The Netherlands
| | - Abel A Vlasblom
- Department of Infectious Diseases and Immunology (I&I), Faculty of Veterinary Medicine, Utrecht University, Yalelaan 1, 3584 CL, Utrecht, The Netherlands
| | - Birgitta Duim
- Department of Infectious Diseases and Immunology (I&I), Faculty of Veterinary Medicine, Utrecht University, Yalelaan 1, 3584 CL, Utrecht, The Netherlands
| | - Peter Scherpenisse
- Institute for Risk Assessment Sciences (IRAS), Faculty of Veterinary Medicine, Utrecht University, Yalelaan 2, 3584 CM Utrecht, The Netherlands
| | - Isabella J van Schothorst
- Institute for Risk Assessment Sciences (IRAS), Faculty of Veterinary Medicine, Utrecht University, Yalelaan 2, 3584 CM Utrecht, The Netherlands
| | - Inge M Wouters
- Institute for Risk Assessment Sciences (IRAS), Faculty of Veterinary Medicine, Utrecht University, Yalelaan 2, 3584 CM Utrecht, The Netherlands
| | - Liese Van Gompel
- Institute for Risk Assessment Sciences (IRAS), Faculty of Veterinary Medicine, Utrecht University, Yalelaan 2, 3584 CM Utrecht, The Netherlands
| | - Lidwien A M Smit
- Institute for Risk Assessment Sciences (IRAS), Faculty of Veterinary Medicine, Utrecht University, Yalelaan 2, 3584 CM Utrecht, The Netherlands
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The European Union Summary Report on Antimicrobial Resistance in zoonotic and indicator bacteria from humans, animals and food in 2020/2021. EFSA J 2023; 21:e07867. [PMID: 36891283 PMCID: PMC9987209 DOI: 10.2903/j.efsa.2023.7867] [Citation(s) in RCA: 48] [Impact Index Per Article: 48.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023] Open
Abstract
Antimicrobial resistance (AMR) data on zoonotic and indicator bacteria from humans, animals and food are collected annually by the EU Member States (MSs) and reporting countries, jointly analysed by EFSA and ECDC and presented in a yearly EU Summary Report. This report provides an overview of the main findings of the 2020-2021 harmonised AMR monitoring in Salmonella spp., Campylobacter jejuni and C. coli in humans and food-producing animals (broilers, laying hens and turkeys, fattening pigs and bovines under 1 year of age) and relevant meat thereof. For animals and meat thereof, indicator E. coli data on the occurrence of AMR and presumptive Extended spectrum β-lactamases (ESBL)-/AmpC β-lactamases (AmpC)-/carbapenemases (CP)-producers, as well as the occurrence of methicillin-resistant Staphylococcus aureus are also analysed. In 2021, MSs submitted for the first time AMR data on E. coli isolates from meat sampled at border control posts. Where available, monitoring data from humans, food-producing animals and meat thereof were combined and compared at the EU level, with emphasis on multidrug resistance, complete susceptibility and combined resistance patterns to selected and critically important antimicrobials, as well as Salmonella and E. coli isolates exhibiting ESBL-/AmpC-/carbapenemase phenotypes. Resistance was frequently found to commonly used antimicrobials in Salmonella spp. and Campylobacter isolates from humans and animals. Combined resistance to critically important antimicrobials was mainly observed at low levels except in some Salmonella serotypes and in C. coli in some countries. The reporting of a number of CP-producing E. coli isolates (harbouring bla OXA-48, bla OXA-181, and bla NDM-5 genes) in pigs, bovines and meat thereof by a limited number of MSs (4) in 2021, requests a thorough follow-up. The temporal trend analyses in both key outcome indicators (rate of complete susceptibility and prevalence of ESBL-/AmpC- producers) showed that encouraging progress have been registered in reducing AMR in food-producing animals in several EU MSs over the last years.
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Khairullah AR, Kurniawan SC, Effendi MH, Sudjarwo SA, Ramandinianto SC, Widodo A, Riwu KHP, Silaen OSM, Rehman S. A review of new emerging livestock-associated methicillin-resistant Staphylococcus aureus from pig farms. Vet World 2023; 16:46-58. [PMID: 36855358 PMCID: PMC9967705 DOI: 10.14202/vetworld.2023.46-58] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 11/22/2022] [Indexed: 01/12/2023] Open
Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) is a S. aureus strain resistant to β-lactam antibiotics and is often associated with livestock, known as livestock-associated (LA)-MRSA. Using molecular typing with multi-locus sequence typing, MRSA clones have been classified in pigs, including clonal complex 398. Livestock-associated-methicillin-resistant S. aureus was first discovered in pigs in the Netherlands in 2005. Since then, it has been widely detected in pigs in other countries. Livestock-associated-methicillin-resistant S. aureus can be transmitted from pigs to pigs, pigs to humans (zoonosis), and humans to humans. This transmission is enabled by several risk factors involved in the pig trade, including the use of antibiotics and zinc, the size and type of the herd, and the pig pen management system. Although LA-MRSA has little impact on the pigs' health, it can be transmitted from pig to pig or from pig to human. This is a serious concern as people in direct contact with pigs are highly predisposed to acquiring LA-MRSA infection. The measures to control LA-MRSA spread in pig farms include conducting periodic LA-MRSA screening tests on pigs and avoiding certain antibiotics in pigs. This study aimed to review the emerging LA-MRSA strains in pig farms.
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Affiliation(s)
- Aswin Rafif Khairullah
- Doctoral Program in Veterinary Science, Faculty of Veterinary Medicine, Universitas Airlangga. Jl. Dr. Ir. H. Soekarno, Kampus C Mulyorejo, Surabaya 60115, East Java, Indonesia
| | - Shendy Canadya Kurniawan
- Master Program of Animal Sciences, Department of Animal Sciences, Specialisation in Molecule, Cell and Organ Functioning, Wageningen University and Research, Wageningen 6708 PB, Netherlands
| | - Mustofa Helmi Effendi
- Department of Veterinary Public Health, Faculty of Veterinary Medicine, Universitas Airlangga. Jl. Dr. Ir. H. Soekarno, Kampus C Mulyorejo, Surabaya 60115, East Java, Indonesia,Corresponding author: Mustofa Helmi Effendi, e-mail: Co-authors: ARK: , SCK: , SAS: , SCR: , AW: , KHPR: , OSMS: , SR:
| | - Sri Agus Sudjarwo
- Department of Veterinary Pharmacology, Faculty of Veterinary Medicine, Universitas Airlangga. Jl. Dr. Ir. H. Soekarno, Kampus C Mulyorejo, Surabaya 60115, East Java, Indonesia
| | | | - Agus Widodo
- Doctoral Program in Veterinary Science, Faculty of Veterinary Medicine, Universitas Airlangga. Jl. Dr. Ir. H. Soekarno, Kampus C Mulyorejo, Surabaya 60115, East Java, Indonesia
| | - Katty Hendriana Priscilia Riwu
- Doctoral Program in Veterinary Science, Faculty of Veterinary Medicine, Universitas Airlangga. Jl. Dr. Ir. H. Soekarno, Kampus C Mulyorejo, Surabaya 60115, East Java, Indonesia
| | - Otto Sahat Martua Silaen
- Doctoral Program in Biomedical Science, Faculty of Medicine, Universitas Indonesia, Jl. Salemba Raya No. 6 Senen, Jakarta 10430, Indonesia
| | - Saifur Rehman
- Doctoral Program in Veterinary Science, Faculty of Veterinary Medicine, Universitas Airlangga. Jl. Dr. Ir. H. Soekarno, Kampus C Mulyorejo, Surabaya 60115, East Java, Indonesia
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Khairullah AR, Sudjarwo SA, Effendi MH, Ramandinianto SC, Gelolodo MA, Widodo A, Riwu KHP, Kurniawati DA. Review of pork and pork products as a source for transmission of methicillin-resistant Staphylococcus aureus. INTERNATIONAL JOURNAL OF ONE HEALTH 2022. [DOI: 10.14202/ijoh.2022.167-177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) is an opportunistic bacterium that can cause infection in animals and humans. Recently, MRSA from food-producing or farm animals has been identified as livestock-associated MRSA (LA-MRSA). The spread of LA-MRSA is particularly found in pork and pork products because LA-MRSA has been widely known to infect pigs. The most common type of LA-MRSA identified in pork and pork products is the clonal complex LA-MRSA 398 (LA-MRSA CC398). The MRSA strains on the surface of pork carcasses can be spread during the handling and processing of pork and pork products through human hands, cutting tools, and any surface that comes into direct contact with pork. Food infection is the main risk of MRSA in pork and pork products consumed by humans. Antibiotics to treat food infection cases due to MRSA infection include vancomycin and tigecycline. The spread of MRSA in pork and pork products is preventable by appropriately cooking and cooling the pork and pork products at temperatures above 60°C and below 5°C, respectively. It is also necessary to take other preventive measures, such as having a clean meat processing area and disinfecting the equipment used for processing pork and pork products. This review aimed to explain epidemiology, transmission, risk factors, diagnosis, public health consequences, treatment of food poisoning, and preventing the spread of MRSA in pork and pork products.
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Affiliation(s)
- Aswin Rafif Khairullah
- Doctoral Program in Veterinary Science, Faculty of Veterinary Medicine, Universitas Airlangga, Surabaya, Indonesia
| | - Sri Agus Sudjarwo
- Department of Veterinary Pharmacology, Faculty of Veterinary Medicine, Universitas Airlangga, Surabaya, Indonesia
| | - Mustofa Helmi Effendi
- Department of Veterinary Public Health, Faculty of Veterinary Medicine, Universitas Airlangga, Surabaya, Indonesia
| | - Sancaka Cashyer Ramandinianto
- Master Program in Veterinary Disease and Public Health, Faculty of Veterinary Medicine, Universitas Airlangga, Surabaya, Indonesia
| | - Maria Aega Gelolodo
- Department of Animal Infectious Diseases and Veterinary Public Health, Faculty of Medicine and Veterinary Medicine, Universitas Nusa Cendana, Kupang, Indonesia
| | - Agus Widodo
- Doctoral Program in Veterinary Science, Faculty of Veterinary Medicine, Universitas Airlangga, Surabaya, Indonesia
| | | | - Dyah Ayu Kurniawati
- Master Program in Veterinary Disease and Public Health, Faculty of Veterinary Medicine, Universitas Airlangga, Surabaya, Indonesia
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Rao S, Linke L, Magnuson R, Jaunch L, Hyatt DR. Antimicrobial resistance and genetic diversity of Staphylococcus aureus collected from livestock, poultry and humans. One Health 2022; 15:100407. [PMID: 36277090 PMCID: PMC9582408 DOI: 10.1016/j.onehlt.2022.100407] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Revised: 05/13/2022] [Accepted: 06/05/2022] [Indexed: 10/30/2022] Open
Abstract
Staphylococcus aureus is one of the most prominent nosocomial, community and farm acquired bacterial infections among animals and human populations. The main purpose of our study was to identify and characterize antimicrobial resistance (AMR) among Staphylococcus aureus isolated from livestock, poultry and humans and to further identify the associated genes. Staphylococcus aureus isolates from human, bovine, swine and poultry were collected from different laboratories across the United States collected between 2003 and 2016. Antimicrobial susceptibility testing for 13 antimicrobials was performed and conventional PCR was used to detect the presence of the nuc gene, mec gene, and to detect int1 gene. Associations between the presence of mec and intl and specific AMR profiles were determined. Antimicrobial resistance was detected in all four host categories, with the highest overall rates found in swine, 100% resistant to tetracycline, 88% to penicillin and 64% clindamycin. The next highest was found among humans with 81.6% of isolates resistant to penicillin followed by 44% to clindamycin and 43% to erythromycin. Among beef cattle isolates, 63.2% were resistant to penicillin, 15.8% resistant to clindamycin and 15.8% to erythromycin. No isolates from any of the hosts were resistant to linezolid. Among poultry isolates, the highest AMR was found to clindamycin, followed by erythromycin and penicillin. Among dairy cattle, highest resistance was found to penicillin, followed by chloramphenicol and gentamicin. Dairy cattle were the only host category with isolates that are resistant to trimethoprim-sulfamethoxazole. Of the 220 isolates detected by latex agglutination, 217 were confirmed to be S. aureus via PCR of the nuc gene, 21.4% were positive for the mecA gene. Swine had the highest prevalence of the mecA gene, followed by humans, poultry and beef cattle. This study has demonstrated a high occurrence of penicillin resistance among all S. aureus isolates. There were differences observed between host species with tetracycline resistance being the highest among swine isolates and clindamycin being highest in poultry isolates. No detection of oxacillin resistance was found in isolates from dairy cattle but was found in isolates from all of the other host species, 94% of which contained the mecA gene. High occurrence of penicillin resistance in Staphylococcus aureus isolates collected from livestock, poultry and humans. Tetracycline resistance was the highest among swine isolates and clindamycin was the highest in poultry isolates. Oxacillin resistance was not detected among dairy cattle isolates but was found in isolates from other host species. Ninety four percent of the S. aureus isolates were resistant to oxacillin contained the mecA gene.
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Golob M, Pate M, Kušar D, Zajc U, Papić B, Ocepek M, Zdovc I, Avberšek J. Antimicrobial Resistance and Molecular Characterization of Methicillin-Resistant Staphylococcus aureus from Two Pig Farms: Longitudinal Study of LA-MRSA. Antibiotics (Basel) 2022; 11:1532. [PMID: 36358187 PMCID: PMC9687068 DOI: 10.3390/antibiotics11111532] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 10/27/2022] [Accepted: 10/31/2022] [Indexed: 10/29/2023] Open
Abstract
Pigs were identified as the most important reservoir of livestock-associated methicillin-resistant Staphylococcus aureus (LA-MRSA), mostly belonging to the emergent zoonotic clonal complex (CC) 398. Here, we investigated the presence of MRSA in sows and piglets over a period of several months in two pig farms (intensive farm A and family-run farm B). Isolates underwent antimicrobial susceptibility testing, PCR characterization and spa typing. We collected 280 samples, namely 206 nasal swabs from pigs and 74 environmental samples from pig housings at 12 consecutive time points. A total of 120/161 (74.5%) and 75/119 (63.0%) samples were MRSA-positive in farms A and B, respectively. All isolates harbored mecA but lacked mecC and PVL-encoding genes. The identified spa types (t571, t034, t1250 and t898 in farm A, t1451 and t011 in farm B) were indicative of CC398. Antimicrobial resistance patterns (all multidrug resistant in farm A, 57.2% in farm B) depended on the farm, suggesting the impact of farm size and management practices on the prevalence and characteristics of MRSA. Due to the intermittent colonization of pigs and the high contamination of their immediate environment, MRSA status should be determined at the farm level when considering preventive measures or animal trade between farms.
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Affiliation(s)
- Majda Golob
- Institute of Microbiology and Parasitology, Veterinary Faculty, University of Ljubljana, Gerbičeva 60, SI-1000 Ljubljana, Slovenia
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Schouls LM, Veldman K, Brouwer MSM, Dierikx C, Witteveen S, van Santen-Verheuvel M, Hendrickx APA, Landman F, Hengeveld P, Wullings B, Rapallini M, Wit B, van Duijkeren E. cfr and fexA genes in methicillin-resistant Staphylococcus aureus from humans and livestock in the Netherlands. COMMUNICATIONS MEDICINE 2022; 2:135. [PMID: 36317053 PMCID: PMC9616846 DOI: 10.1038/s43856-022-00200-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 10/06/2022] [Indexed: 11/09/2022] Open
Abstract
Background Although the Netherlands is a country with a low endemic level of methicillin-resistant Staphylococcus aureus (MRSA), a national MRSA surveillance has been in place since 1989. In 2003 livestock emerged as a major reservoir of MRSA and currently livestock-associated MRSA (clonal complex CC398) make up 25% of all surveillance isolates. To assess possible transfer of resistant strains or resistance genes, MRSA obtained from humans and animals were characterized in detail. Methods The sequenced genomes of 6327 MRSA surveillance isolates from humans and from 332 CC398 isolates from livestock-related samples were analyzed and resistance genes were identified. Several isolates were subjected to long-read sequencing to reconstruct chromosomes and plasmids. Results Here we show the presence of the multi-resistance gene cfr in seven CC398 isolates obtained from humans and in one CC398 isolate from a pig-farm dust sample. Cfr induces resistance against five antibiotic classes, which is true for all but two isolates. The isolates are genetically unrelated, and in seven of the isolates cfr are located on distinct plasmids. The fexA gene is found in 3.9% surveillance isolates and in 7.5% of the samples from livestock. There is considerable sequence variation of fexA and geographic origin of the fexA alleles. Conclusions The rare cfr and fexA resistance genes are found in MRSA from humans and animals in the Netherlands, but there is no evidence for spread of resistant strains or resistance plasmids. The proportion of cfr-positive MRSA is low, but its presence is worrying and should be closely monitored.
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Affiliation(s)
- Leo M. Schouls
- grid.31147.300000 0001 2208 0118National Institute for Public Health and the Environment (RIVM), Infectious Diseases Research, Diagnostics and laboratory Surveillance (IDS), Bilthoven, The Netherlands
| | - Kees Veldman
- grid.4818.50000 0001 0791 5666Wageningen Bioveterinary Research (WBVR), Bacteriology, Host Pathogen Interaction & Diagnostics, Lelystad, The Netherlands
| | - Michael S. M. Brouwer
- grid.4818.50000 0001 0791 5666Wageningen Bioveterinary Research (WBVR), Bacteriology, Host Pathogen Interaction & Diagnostics, Lelystad, The Netherlands
| | - Cindy Dierikx
- grid.31147.300000 0001 2208 0118National Institute for Public Health and the Environment (RIVM), Zoonoses and Environmental Microbiology (Z&O), Bilthoven, The Netherlands
| | - Sandra Witteveen
- grid.31147.300000 0001 2208 0118National Institute for Public Health and the Environment (RIVM), Infectious Diseases Research, Diagnostics and laboratory Surveillance (IDS), Bilthoven, The Netherlands
| | - Marga van Santen-Verheuvel
- grid.31147.300000 0001 2208 0118National Institute for Public Health and the Environment (RIVM), Infectious Diseases Research, Diagnostics and laboratory Surveillance (IDS), Bilthoven, The Netherlands
| | - Antoni P. A. Hendrickx
- grid.31147.300000 0001 2208 0118National Institute for Public Health and the Environment (RIVM), Infectious Diseases Research, Diagnostics and laboratory Surveillance (IDS), Bilthoven, The Netherlands
| | - Fabian Landman
- grid.31147.300000 0001 2208 0118National Institute for Public Health and the Environment (RIVM), Infectious Diseases Research, Diagnostics and laboratory Surveillance (IDS), Bilthoven, The Netherlands
| | - Paul Hengeveld
- grid.31147.300000 0001 2208 0118National Institute for Public Health and the Environment (RIVM), Zoonoses and Environmental Microbiology (Z&O), Bilthoven, The Netherlands
| | - Bart Wullings
- grid.4818.50000 0001 0791 5666Wageningen Food Safety Research, Team Bacteriology, Molecular Biology & AMR, Wageningen, The Netherlands
| | - Michel Rapallini
- grid.4818.50000 0001 0791 5666Wageningen Food Safety Research, Team Bacteriology, Molecular Biology & AMR, Wageningen, The Netherlands
| | - Ben Wit
- grid.435742.30000 0001 0726 7822Netherlands Food and Consumer Product Safety Authority (NVWA), Food safety, Apeldoorn, The Netherlands
| | - Engeline van Duijkeren
- grid.31147.300000 0001 2208 0118National Institute for Public Health and the Environment (RIVM), Zoonoses and Environmental Microbiology (Z&O), Bilthoven, The Netherlands
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11
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Aerts M, Battisti A, Hendriksen R, Larsen J, Nilsson O, Abrahantes JC, Guerra B, Papanikolaou A, Beloeil PA. Technical specifications for a baseline survey on the prevalence of methicillin-resistant Staphylococcus aureus (MRSA) in pigs. EFSA J 2022; 20:e07620. [PMID: 36267542 PMCID: PMC9579990 DOI: 10.2903/j.efsa.2022.7620] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
The European Commission requested scientific and technical assistance in the preparation of a EU‐wide baseline survey protocol for a European Union (EU) coordinated monitoring programme on the prevalence of methicillin‐resistant Staphylococcus Aureus (MRSA) in pigs. The objective of the survey is to estimate the MRSA prevalence in batches of fattening pigs at slaughter at both European and national levels, with a 95% level of confidence and a level of precision of 10% considering an expected prevalence of 50%. The survey protocol defines the target population, the sample size for the survey, sample collection requirements, the analytical methods (for isolation, identification, phenotypic susceptibility testing and further genotypic testing of MRSA isolates), the data reporting requirements and the plan of analysis. The samples are to be analysed according to the laboratory protocols available on the European Union Reference Laboratory (EURL‐AR) website. Generalised linear models will be used to estimate proportion (with 95% confidence intervals) of batches of slaughter pigs tested positive to MRSA. The necessary data to be reported by the EU Member States to support this baseline survey are presented in three data models. The results of the survey should be reported using the EFSA data collection framework.
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12
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Molecular epidemiology of methicillin-resistant Staphylococcus aureus isolated from pigs in Japan. Vet Microbiol 2022; 273:109523. [DOI: 10.1016/j.vetmic.2022.109523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 06/14/2022] [Accepted: 07/27/2022] [Indexed: 11/19/2022]
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13
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Abreu R, Rodríguez-Álvarez C, Castro-Hernandez B, Lecuona-Fernández M, González JC, Rodríguez-Novo Y, Arias Rodríguez MDLA. Prevalence and Characterisation of Multiresistant Bacterial Strains Isolated in Pigs from the Island of Tenerife. Vet Sci 2022; 9:vetsci9060269. [PMID: 35737321 PMCID: PMC9230743 DOI: 10.3390/vetsci9060269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 05/26/2022] [Accepted: 06/01/2022] [Indexed: 11/20/2022] Open
Abstract
Background: Antibiotic-resistant bacteria can circulate among human and animal populations through direct contact with animals, as well as via food and the environment. The purpose of this study was to examine the prevalence and characterisation of multiresistant bacteria in pig samples. Methods: 224 samples of pig livestock were taken at the slaughterhouse on the island of Tenerife. A nasal and a rectal sample were collected from each pig. The presence of methicillin-resistant Staphylococcus aureus (MRSA), methicillin-resistant Staphylococcus coagulase-negative (MRCoNS), vancomycin-resistant Enterococcus (VRE), extended-spectrum ß-lactamase-producing Enterobacteriaceae (BLEE), carbapenemase-producing Enterobacteriaceae (CPE), and colistin-resistant Enterobacteriaceae was investigated. The resistance genes of the isolated bacteria were characterised by specific PCRs depending on the microorganism to be studied, and in vitro antimicrobial resistance was determined using the broth microdilution method (Vitek®2 system bioMérieux®, Nurtingen, Germany). Results: MRSA prevalence was 73.21% (164 isolates). MRCoNS prevalence was 9.8% (22 isolates), S. sciuri being the prevalent species. Six isolates presented a 2.7% prevalence of extended-spectrum ß-lactamase-producing Escherichia coli (BLEE) in the CTX-M-1 group. No vancomycin-resistant Enterococcus (VRE), carbapenemase-producing Enterobacteriaceae (CRE), or colistin-resistant Enterobacteriaceae were isolated. Conclusion: we found a high presence of multiresistant bacteria, suggesting the need for increased control and surveillance of this type of strains in pig livestock and a better understanding of the possible transmission routes of these microorganisms through livestock products.
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Affiliation(s)
- Rossana Abreu
- Department of Preventive Medicine and Public Health, University of La Laguna, Campus de Ofra, s/n, 38071 Santa Cruz de Tenerife, Spain; (R.A.); (C.R.-Á.)
| | - Cristobalina Rodríguez-Álvarez
- Department of Preventive Medicine and Public Health, University of La Laguna, Campus de Ofra, s/n, 38071 Santa Cruz de Tenerife, Spain; (R.A.); (C.R.-Á.)
| | - Beatriz Castro-Hernandez
- Microbiology and Infection Control Service, University Hospital of the Canary Islands, Canary Islands, Tenerife, 38320 San Cristóbal de La Laguna, Spain; (B.C.-H.); (M.L.-F.)
| | - Maria Lecuona-Fernández
- Microbiology and Infection Control Service, University Hospital of the Canary Islands, Canary Islands, Tenerife, 38320 San Cristóbal de La Laguna, Spain; (B.C.-H.); (M.L.-F.)
| | - Juan Carlos González
- Canary Islands Health Service, Canary Islands, 38004 Santa Cruz de Tenerife, Spain;
| | - Yurena Rodríguez-Novo
- Faculty of Health Sciences, Nursing Section, University of La Laguna, Tenerife, 38200 La Laguna, Spain;
| | - Maria de los Angeles Arias Rodríguez
- Department of Preventive Medicine and Public Health, University of La Laguna, Campus de Ofra, s/n, 38071 Santa Cruz de Tenerife, Spain; (R.A.); (C.R.-Á.)
- Correspondence: ; Tel.: +34-922-319-369
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14
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Shoaib M, Aqib AI, Ali MM, Ijaz M, Sattar H, Ghaffar A, Sajid Hasni M, Bhutta ZA, Ashfaq K, Kulyar MFEA, Pu W. Tracking Infection and Genetic Divergence of Methicillin-Resistant Staphylococcus aureus at Pets, Pet Owners, and Environment Interface. Front Vet Sci 2022; 9:900480. [PMID: 35720840 PMCID: PMC9201917 DOI: 10.3389/fvets.2022.900480] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Accepted: 04/12/2022] [Indexed: 11/30/2022] Open
Abstract
Staphylococcus aureus (S. aureus) has become a leading animal and public health pathogen that keeps on transferring from one host to other, giving rise to newer strains by genetic shifts. The current study was designed to investigate the epidemiology and genetic relatedness of mecA gene in S. aureus isolated from pets, immediate individuals in contact with pets, and veterinary clinic environments. A total of n = 300 samples were collected from different veterinary hospitals in Pakistan using convenience sampling. The collected samples were subjected to microbiological and biochemical examination for the isolation of S. aureus. Methicillin resistance was investigated by both phenotypically using oxacillin disk diffusion assay and by genotypically targeting mecA gene by PCR. PCR amplicons were subjected for sequencing by Sanger method of sequencing, which were subsequently submitted to NCBI GenBank under the accession numbers MT874770, MT874771, and MT874772. Sequence evolutionary analysis and mecA gene characterization was done using various bioinformatics tools. Overall, 33.66% mecA genes harboring S. aureus strains were isolated from all sources (33.33% from pets, 46.0% from surrounding, and 28.0% from immediate contact individuals). The bioinformatics analysis noted that one SNP was identified at position c.253C>A (Transvertion). The phylogenetic tree (two clades) of S. aureus mecA revealed a possibility of inter-transmission of disease between the environment and pets. Frequency of adenine and thymine nucleotide in motifs were found to be the same (0.334). Cytosine and guanine frequency were also the same (0.166). Threonine was replaced by asparagine (p.T84D) in each sample of cat, environment, and human. On the other hand, protein structures ofcat-1 and cat-2 proteins were found identical while cat-3, environmental, and human proteins shared identical structures. The study thus concludes rising circulation of methicillin-resistant S. aureus (MRSA) strains in animal-human-environment interfaces, forecasting the development of novel strains withmodified range of resistance.
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Affiliation(s)
- Muhammad Shoaib
- Key Laboratory of New Animal Drug Project, Gansu Province, Key Laboratory of Veterinary Pharmaceutical Development, Ministry of Agriculture and Rural Affairs, Lanzhou Institute of Husbandry and Pharmaceutical Sciences of CAAS, Lanzhou, China
- Institute of Microbiology, Faculty of Veterinary Science, University of Agriculture Faisalabad, Faisalabad, Pakistan
| | - Amjad Islam Aqib
- Department of Medicine, Cholistan University of Veterinary and Animal Sciences, Bahawalpur, Pakistan
| | - Muhammad Muddassir Ali
- Institute of Biochemistry and Biotechnology, University of Veterinary and Animal Sciences, Lahore, Pakistan
| | - Muhammad Ijaz
- Department of Veterinary Medicine, University of Veterinary and Animal Sciences, Lahore, Pakistan
| | - Huma Sattar
- Institute of Molecular Biology and Biotechnology, The University of Lahore, Lahore, Pakistan
| | - Awais Ghaffar
- Department of Clinical Sciences, KBCMA, College of Veterinary and Animal Sciences, Narowal, University of Veterinary and Animal Sciences, Lahore, Pakistan
| | - Muhammad Sajid Hasni
- Directorate General Farms and Feed Resources, Livestock and Dairy Development Department, Quetta, Pakistan
| | - Zeeshan Ahmad Bhutta
- Laboratory of Biochemistry and Immunology, College of Veterinary Medicine, Chungbuk National University, Cheongju, South Korea
| | - Khurram Ashfaq
- Department of Clinical Medicine and Surgery, University of Agriculture, Faisalabad, Pakistan
| | | | - Wanxia Pu
- Key Laboratory of New Animal Drug Project, Gansu Province, Key Laboratory of Veterinary Pharmaceutical Development, Ministry of Agriculture and Rural Affairs, Lanzhou Institute of Husbandry and Pharmaceutical Sciences of CAAS, Lanzhou, China
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15
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Dynamics of the Human Nasal Microbiota and Staphylococcus aureus CC398 Carriage in Pig Truck Drivers across One Workweek. Appl Environ Microbiol 2021; 87:e0122521. [PMID: 34191530 PMCID: PMC8388827 DOI: 10.1128/aem.01225-21] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Drivers of pig trucks constitute a potential route of human transmission of livestock-associated methicillin-resistant Staphylococcus aureus clonal complex 398 (LA-MRSA CC398). In this study, we determined MRSA prevalence in pig truck drivers (n = 47) and monitored the nasal microbiota of 9 drivers 3 times daily throughout 1 workweek (n = 113 samples) and compared it to that of their spouses (n = 25 samples from 6 spouses) and 89 nonexposed subjects. S. aureus isolates (n = 232) derived from a subset of nasal and truck samples were whole-genome sequenced. The nasal alpha diversity of drivers in the beginning of the workday was lower than that of nonexposed subjects. During the workday, it increased significantly. Similarly, the drivers’ nasal composition shifted during the workday, becoming increasingly different from that of their spouses and nonexposed individuals. Clustering into community state types (CSTs) revealed frequent switches from either S. aureus- or Corynebacterium-dominated CSTs in the mornings to a Psychrobacter-dominated CST during the workday. Six intermittent MRSA carriers were mostly MRSA negative in the mornings, and their nasal microbiota resembled that of nonexposed subjects. When acquiring MRSA during the workday, they switched to the Psychrobacter-dominated CST. In contrast, the nasal microbiota of two persistent MRSA carriers was dominated by staphylococci. In conclusion, we show that the nasal microbiota of pig truck drivers is very dynamic, undergoes drastic changes during workdays, and differs from that of nonexposed subjects even before pig contact. MRSA-carrying drivers may eventually introduce MRSA into the community and health care facilities. Carriage dynamics, however, showed that for most drivers, CC398 MRSA is rapidly lost and only rarely causes transmission to spouses. IMPORTANCE In Denmark, the number of human methicillin-resistant Staphylococcus aureus (MRSA) cases has increased dramatically since the early 2000s, starting from imported cases and spreading in the community. However, today, approximately one-third of all new cases are attributed to livestock-associated MRSA clonal complex 398 (LA-MRSA CC398). This mirrors the increase in pig farms, of which 95% are now positive for LA-MRSA, and this has been caused mainly by three dominant lineages enriched for a number of key antimicrobial resistance genes. Although most human LA-MRSA CC398 infections in Denmark are linked to livestock contact, still up to one-third are not. Pig truck drivers constitute a previously understudied occupation group which may transmit LA-MRSA CC398 to household members, the community, and hospitals. In this study, we demonstrate dramatic work-related changes in the nasal microbiota of pig truck drivers, as well as in their carriage of LA-MRSA CC398. However, they likely do not constitute an important reservoir for LA-MRSA CC398 dissemination.
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16
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Differential Analysis of Longitudinal Methicillin-Resistant Staphylococcus aureus Colonization in Relation to Microbial Shifts in the Nasal Microbiome of Neonatal Piglets. mSystems 2021; 6:e0015221. [PMID: 34282937 PMCID: PMC8407314 DOI: 10.1128/msystems.00152-21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) is an important human pathogen and often colonizes pigs. To lower the risk of MRSA transmission to humans, a reduction of MRSA prevalence and/or load in pig farms is needed. The nasal microbiome contains commensal species that may protect against MRSA colonization and may be used to develop competitive exclusion strategies. To obtain a comprehensive understanding of the species that compete with MRSA in the developing porcine nasal microbiome, and the moment of MRSA colonization, we analyzed nasal swabs from piglets in two litters. The swabs were taken longitudinally, starting directly after birth until 6 weeks. Both 16S rRNA and tuf gene sequencing data with different phylogenetic resolutions and complementary culture-based and quantitative real-time PCR (qPCR)-based MRSA quantification data were collected. We employed a compositionally aware bioinformatics approach (CoDaSeq + rmcorr) for analysis of longitudinal measurements of the nasal microbiota. The richness and diversity in the developing nasal microbiota increased over time, albeit with a reduction of Firmicutes and Actinobacteria, and an increase of Proteobacteria. Coabundant groups (CAGs) of species showing strong positive and negative correlation with colonization of MRSA and S. aureus were identified. Combining 16S rRNA and tuf gene sequencing provided greater Staphylococcus species resolution, which is necessary to inform strategies with potential protective effects against MRSA colonization in pigs. IMPORTANCE The large reservoir of methicillin-resistant Staphylococcus aureus (MRSA) in pig farms imposes a significant zoonotic risk. An effective strategy to reduce MRSA colonization in pig farms is competitive exclusion whereby MRSA colonization can be reduced by the action of competing bacterial species. We complemented 16S rRNA gene sequencing with Staphylococcus-specific tuf gene sequencing to identify species anticorrelating with MRSA colonization. This approach allowed us to elucidate microbiome dynamics and identify species that are negatively and positively associated with MRSA, potentially suggesting a route for its competitive exclusion.
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17
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Park S, Ronholm J. Staphylococcus aureus in Agriculture: Lessons in Evolution from a Multispecies Pathogen. Clin Microbiol Rev 2021; 34:e00182-20. [PMID: 33568553 PMCID: PMC7950364 DOI: 10.1128/cmr.00182-20] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Staphylococcus aureus is a formidable bacterial pathogen that is responsible for infections in humans and various species of wild, companion, and agricultural animals. The ability of S. aureus to move between humans and livestock is due to specific characteristics of this bacterium as well as modern agricultural practices. Pathoadaptive clonal lineages of S. aureus have emerged and caused significant economic losses in the agricultural sector. While humans appear to be a primary reservoir for S. aureus, the continued expansion of the livestock industry, globalization, and ubiquitous use of antibiotics has increased the dissemination of pathoadaptive S. aureus in this environment. This review comprehensively summarizes the available literature on the epidemiology, pathophysiology, genomics, antibiotic resistance (ABR), and clinical manifestations of S. aureus infections in domesticated livestock. The availability of S. aureus whole-genome sequence data has provided insight into the mechanisms of host adaptation and host specificity. Several lineages of S. aureus are specifically adapted to a narrow host range on a short evolutionary time scale. However, on a longer evolutionary time scale, host-specific S. aureus has jumped the species barrier between livestock and humans in both directions several times. S. aureus illustrates how close contact between humans and animals in high-density environments can drive evolution. The use of antibiotics in agriculture also drives the emergence of antibiotic-resistant strains, making the possible emergence of human-adapted ABR strains from agricultural practices concerning. Addressing the concerns of ABR S. aureus, without negatively affecting agricultural productivity, is a challenging priority.
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Affiliation(s)
- Soyoun Park
- Faculty of Agricultural and Environmental Sciences, McGill University, Sainte-Anne-de-Bellevue, Quebec, Canada
| | - Jennifer Ronholm
- Faculty of Agricultural and Environmental Sciences, McGill University, Sainte-Anne-de-Bellevue, Quebec, Canada
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18
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Methicillin-Resistant Staphylococci and Macrococci at the Interface of Human and Animal Health. Toxins (Basel) 2021; 13:toxins13010061. [PMID: 33466773 PMCID: PMC7831011 DOI: 10.3390/toxins13010061] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 01/11/2021] [Indexed: 02/07/2023] Open
Abstract
The global impact of methicillin-resistant Staphylococcus aureus (MRSA) clonal lineages on human and animal health continues, even considering the decreasing MRSA rates in some parts of the world [...].
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19
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Abstract
Abstract
This study was performed to investigate the occurrence of livestock-associated methicillin-resistant Staphylococcus aureus (LA-MRSA) in batches of pigs at slaughter and at different stages along the slaughter line. Nasal and ear skin swabs were collected from 105 batches of 10 pigs at six abattoirs. Cultures (pooled or individual) were performed for MRSA using selective media; presumptive MRSA were confirmed by mecA and nuc gene detection and a selection was spa-typed. MRSA was detected in 46 batches. All spa-types detected were those associated with LA-MRSA clonal complex 398. The proportion of positive batches varied among abattoirs (0–100%). Two abattoirs were subsequently further investigated, with samples taken at post-stunning, chiller and either at lairage or post-singe. Results suggested cross-contamination occurred between the lairage and point of post-stunning, but the slaughter processes appeared effective at reducing contamination before carcases entered the chiller. One abattoir provided only negative samples in the initial study and in the subsequent study along the slaughter line (26 batches in total), suggesting differences possibly in the MRSA status of pigs on arrival from supply farms or in its abattoir practices affecting the MRSA status of pigs at the sampling points. This study highlights that in the investigated abattoirs, MRSA was detected in 43.8% of batches of pigs at slaughter using sensitive selective culture methods.
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20
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Local and Transboundary Transmissions of Methicillin-Resistant Staphylococcus aureus Sequence Type 398 through Pig Trading. Appl Environ Microbiol 2020; 86:AEM.00430-20. [PMID: 32358001 DOI: 10.1128/aem.00430-20] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 04/22/2020] [Indexed: 12/25/2022] Open
Abstract
Livestock-associated methicillin-resistant Staphylococcus aureus sequence type (ST) 398 (LA-MRSA ST398) is a genetic lineage for which pigs are regarded as the main reservoir. An increasing prevalence of LA-MRSA ST398 has been reported in areas with high livestock density throughout Europe. In this study, we investigated the drivers contributing to the introduction and spread of LA-MRSA ST398 through the pig farming system in southern Italy. Whole-genome sequencing (WGS) of LA-MRSA ST398 isolates collected in 2018 from pigs (n = 53) and employees (n = 14) from 10 farms in the Calabria region of Italy were comparatively analyzed with previously published WGS data from Italian ST398 isolates (n = 45), an international ST398 reference collection (n = 89), and isolates from Danish pig farms (n = 283), which are the main suppliers of pigs imported to Italy. Single-nucleotide polymorphisms (SNP) were used to infer isolate relatedness, and these data were used together with data from animal trading to identify factors contributing to LA-MRSA ST398 dissemination. The analyses support the existence of two concurrent pathways for the spread of LA-MRSA ST398 in southern Italy: (i) multiple introductions of LA-MRSA ST398 through the import of colonized pigs from other European countries, including Denmark and France, and (ii) the spread of distinct clones dependent on local trading of pigs between farms. Phylogenetically related Italian and Danish LA-MRSA ST398 isolates shared extensive similarities, including carriage of antimicrobial resistance genes. Our findings highlight the potential risk of transboundary transmission of antimicrobial-resistant bacterial clones with a high zoonotic potential during import of pigs from countries with high LA-MRSA prevalence.IMPORTANCE Over the past decade, livestock-associated methicillin-resistant Staphylococcus aureus sequence type 398 (LA-MRSA ST398) has spread among pig holdings throughout Europe, in parallel with the increased incidence of infections among humans, especially in intensive pig farming regions. Despite the growing prevalence of LA-MRSA ST398 in Italian pig farms, the transmission dynamics of this clone in Italy remains unclear. This work provides genome-based evidence to suggest transboundary LA-MRSA ST398 transmission through trading of colonized pigs between European countries and Italy, as well as between farms in the same Italian region. Our findings show that both international trading and local trading of colonized pigs are important factors contributing to the global spread of LA-MRSA ST398 and underscore the need for control measures on and off the farm to reduce the dissemination of this zoonotic pathogen.
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21
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Qu J, Huang Y, Lv X. Crisis of Antimicrobial Resistance in China: Now and the Future. Front Microbiol 2019; 10:2240. [PMID: 31611863 PMCID: PMC6777638 DOI: 10.3389/fmicb.2019.02240] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 09/12/2019] [Indexed: 02/05/2023] Open
Abstract
The crisis of antimicrobial resistance is worsening and has become a major public safety problem in China, seriously endangering human and animal health and ecological environment. Gram-negative bacterial resistance in China is severe: the related pathogens mainly include carbapenem-resistant Acinetobacter, Pseudomonas aeruginosa and Klebsiella pneumoniae. Surging antimicrobial consumption and irrational use of antimicrobials are the main causes of resistance. In China, a variety of strategies are implemented to control the antimicrobial resistance in hospitals, agriculture and environment. However, there is still a long way to go to strengthen the drug resistance surveillance, to reduce the emergence of drug-resistant bacteria, and to find new antimicrobials and therapies for drug-resistant bacteria. Controlling the antimicrobial resistance crisis takes great efforts from the whole society.
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Affiliation(s)
- Junyan Qu
- Center of Infectious Disease, West China Hospital, Sichuan University, Chengdu, China
| | - Yimei Huang
- College of Pharmacy, University of Florida, Gainesville, FL, United States
| | - Xiaoju Lv
- Center of Infectious Disease, West China Hospital, Sichuan University, Chengdu, China
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22
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Amoako DG, Somboro AM, Abia ALK, Allam M, Ismail A, Bester LA, Essack SY. Genome Mining and Comparative Pathogenomic Analysis of An Endemic Methicillin-Resistant Staphylococcus Aureus (MRSA) Clone, ST612-CC8-t1257-SCCmec_IVd(2B), Isolated in South Africa. Pathogens 2019; 8:E166. [PMID: 31569754 PMCID: PMC6963616 DOI: 10.3390/pathogens8040166] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 09/16/2019] [Accepted: 09/17/2019] [Indexed: 12/19/2022] Open
Abstract
This study undertook genome mining and comparative genomics to gain genetic insights into the dominance of the methicillin-resistant Staphylococcus aureus (MRSA) endemic clone ST612-CC8-t1257-SCCmec_IVd(2B), obtained from the poultry food chain in South Africa. Functional annotation of the genome revealed a vast array of similar central metabolic, cellular and biochemical networks within the endemic clone crucial for its survival in the microbial community. In-silico analysis of the clone revealed the possession of uniform defense systems, restriction-modification system (type I and IV), accessory gene regulator (type I), arginine catabolic mobile element (type II), and type 1 clustered, regularly interspaced, short palindromic repeat (CRISPR)Cas array (N = 7 ± 1), which offer protection against exogenous attacks. The estimated pathogenic potential predicted a higher probability (average Pscore ≈ 0.927) of the clone being pathogenic to its host. The clone carried a battery of putative virulence determinants whose expression are critical for establishing infection. However, there was a slight difference in their possession of adherence factors (biofilm operon system) and toxins (hemolysins and enterotoxins). Further analysis revealed a conserved environmental tolerance and persistence mechanisms related to stress (oxidative and osmotic), heat shock, sporulation, bacteriocins, and detoxification, which enable it to withstand lethal threats and contribute to its success in diverse ecological niches. Phylogenomic analysis with close sister lineages revealed that the clone was closely related to the MRSA isolate SHV713 from Australia. The results of this bioinformatic analysis provide valuable insights into the biology of this endemic clone.
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Affiliation(s)
- Daniel Gyamfi Amoako
- Infection Genomics and Applied Bioinformatics Division, Antimicrobial Research Unit, College of Health Sciences, University of KwaZulu-Natal, Durban 4000, South Africa.
- Biomedical Resource Unit, School of Laboratory Medicine and Medical Sciences, College of Health Sciences, University of KwaZulu-Natal; Durban 4000, South Africa.
| | - Anou M Somboro
- Biomedical Resource Unit, School of Laboratory Medicine and Medical Sciences, College of Health Sciences, University of KwaZulu-Natal; Durban 4000, South Africa.
- Antimicrobial Research Unit, College of Health Sciences, University of KwaZulu-Natal, Durban 4000, South Africa.
| | - Akebe Luther King Abia
- Antimicrobial Research Unit, College of Health Sciences, University of KwaZulu-Natal, Durban 4000, South Africa.
| | - Mushal Allam
- Sequencing Core Facility, National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg 2131, South Africa.
| | - Arshad Ismail
- Sequencing Core Facility, National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg 2131, South Africa.
| | - Linda A Bester
- Biomedical Resource Unit, School of Laboratory Medicine and Medical Sciences, College of Health Sciences, University of KwaZulu-Natal; Durban 4000, South Africa.
| | - Sabiha Y Essack
- Antimicrobial Research Unit, College of Health Sciences, University of KwaZulu-Natal, Durban 4000, South Africa.
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Unknown Risk on the Farm: Does Agricultural Use of Ionophores Contribute to the Burden of Antimicrobial Resistance? mSphere 2019; 4:4/5/e00433-19. [PMID: 31554722 PMCID: PMC6763768 DOI: 10.1128/msphere.00433-19] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Ionophores are the second most widely used class of antibiotic in agriculture, with over 4 million kilograms sold in the United States in 2016. Because ionophores are not used in humans, it is widely assumed that their agricultural use will not impact human health. Consequently, these drugs have not been subject to the same regulations as medically important antibiotics. Ionophores are the second most widely used class of antibiotic in agriculture, with over 4 million kilograms sold in the United States in 2016. Because ionophores are not used in humans, it is widely assumed that their agricultural use will not impact human health. Consequently, these drugs have not been subject to the same regulations as medically important antibiotics. Here, I argue that the current evidence base is insufficient to conclude that ionophores do not contribute to human relevant antimicrobial resistance. It is unclear whether ionophore resistance can result in cross-resistance to medically important antibiotics. Moreover, recent evidence suggests that ionophore use may coselect for resistance to vancomycin in some cases. Systematic investigation of the consequences of agricultural ionophore use for human health is therefore imperative.
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Verkola M, Pietola E, Järvinen A, Lindqvist K, Kinnunen PM, Heikinheimo A. Low prevalence of zoonotic multidrug-resistant bacteria in veterinarians in a country with prudent use of antimicrobials in animals. Zoonoses Public Health 2019; 66:667-678. [PMID: 31232511 DOI: 10.1111/zph.12619] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 05/28/2019] [Accepted: 06/05/2019] [Indexed: 12/20/2022]
Abstract
The occurrence of multidrug-resistant zoonotic bacteria in animals has been increasing worldwide. Working in close contact with livestock increases the risk of carriage of these bacteria. We investigated the occurrence of extended-spectrum beta-lactamase (ESBL) and plasmidic AmpC beta-lactamase producing Enterobacteriaceae (ESBL/pAmpC-PE) and livestock-associated methicillin-resistant Staphylococcus aureus (LA-MRSA) in Finnish veterinarians (n = 320). In addition to microbiological samples, background information was collected. Bacterial whole genome sequencing was performed to deduce sequence types (STs), spa types and resistance genes of the isolates. In total, 3.0% (9/297) of the veterinarians carried ESBL producing Escherichia coli, with one ESBL producing E. coli isolate producing also AmpC. Seven different STs, sequences of several different plasmid groups as well as several different blaESBL/pAmpC genes existed in different combinations. No carbapenemase or colistin resistance genes were detected. MRSA was detected in 0.3% (1/320) of the samples. The strain belonged to LA-MRSA clonal complex (CC) 398 (ST398, spa type 011, lacking Panton-Valentine leukocidin genes). In conclusion, this study shows low carriage of multidrug-resistant zoonotic bacteria in Finnish veterinarians. However, finding LA-MRSA for the first time in a sample from a veterinarian in a country with prudent use of animal antimicrobials and regarding the recent rise of LA-MRSA on Finnish pig farms, a strong recommendation to protect people working in close contact with animals carrying LA-MRSA CC398 is given. Further studies are needed to explain why the prevalence of LA-MRSA in veterinarians is lower in Finland than in other European countries.
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Affiliation(s)
- Marie Verkola
- Elintarvikehygienian ja ympäristöterveyden osasto, Eläinlääketieteellinen tiedekunta, Helsingin yliopisto, Helsinki, Finland
| | - Eeva Pietola
- Elintarvikehygienian ja ympäristöterveyden osasto, Eläinlääketieteellinen tiedekunta, Helsingin yliopisto, Helsinki, Finland
| | - Asko Järvinen
- Infektiosairauksien linja, Tulehduskeskus, Helsingin yliopistollinen keskussairaala ja Helsingin yliopisto, Helsinki, Finland
| | - Kristian Lindqvist
- Yliopistopalvelut, Lähipalvelutiimi Viikki, Helsingin yliopisto, Helsinki, Finland
| | - Paula M Kinnunen
- Eläinlääketieteellisten biotieteiden osasto, Eläinlääketieteellinen tiedekunta, Helsingin yliopisto, Helsinki, Finland.,Ruokavirasto, Helsinki, Finland
| | - Annamari Heikinheimo
- Elintarvikehygienian ja ympäristöterveyden osasto, Eläinlääketieteellinen tiedekunta, Helsingin yliopisto, Helsinki, Finland.,Ruokavirasto, Helsinki, Finland
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Amoako DG, Somboro AM, Abia ALK, Allam M, Ismail A, Bester L, Essack SY. Genomic analysis of methicillin-resistant Staphylococcus aureus isolated from poultry and occupational farm workers in Umgungundlovu District, South Africa. THE SCIENCE OF THE TOTAL ENVIRONMENT 2019; 670:704-716. [PMID: 30909047 DOI: 10.1016/j.scitotenv.2019.03.110] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2018] [Revised: 03/06/2019] [Accepted: 03/07/2019] [Indexed: 06/09/2023]
Abstract
This study detected methicillin-resistant Staphylococcus aureus (MRSA) isolates circulating in poultry and farm workers at an intensive poultry production system in uMgungundlovu, South Africa and established the genetic relatedness and characteristics of the isolates using whole genome sequencing (WGS). A total of 145 S. aureus were isolated from poultry (120) and occupational workers (25) in the "farm to fork" continuum (farm, transport, slaughterhouse, and retail points). Twelve MRSA (12/145; 8.3%) isolates were found in the poultry food-chain. MRSA isolates were subjected to antibiotic susceptibility testing against a panel of 20 antibiotics using the broth dilution method and their whole genome was sequenced via the Illumina MiSeq. All the MRSA isolates were multi-drug resistant (MDR) and carried the mecA gene on the SCCmec mobile genetic element (MGE). The majority (11/12) of the MRSA isolates circulating between humans and animals in the continuum belonged to a human-associated clone, ST612-CC8-t1257-SCCmec_IVd (2B), previously reported in South Africa. Other MGEs present in the isolates included: plasmid replicons based on Rep 7 and 20, insertion sequences (IS1182), and prophages (phi2958PVL). Genomic analysis identified a distinct acquired antibiotic resistome in the clone, which accurately predicted the phenotypic antibiograms. Phylogenetic analysis clustered the isolates within the major cluster (I), suggesting the spread of the local dominant multidrug resistance MRSA clone ST612-CC8-t1257-SCCmec_IVd (2B) between humans and animals along the 'farm to fork' continuum. The findings of this study suggest the need to establish appropriate control measures to curb the spread of MDR-MRSA in the food chain.
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Affiliation(s)
- Daniel Gyamfi Amoako
- Antimicrobial Research Unit, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa; Biomedical Resource Unit, School of Laboratory Medicine and Medical Sciences, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa.
| | - Anou Moise Somboro
- Antimicrobial Research Unit, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa; Biomedical Resource Unit, School of Laboratory Medicine and Medical Sciences, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa.
| | - Akebe Luther King Abia
- Antimicrobial Research Unit, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa.
| | - Mushal Allam
- Sequencing Core Facility, National Institute for Communicable Diseases, National Health Laboratory Service, Pretoria, South Africa.
| | - Arshad Ismail
- Sequencing Core Facility, National Institute for Communicable Diseases, National Health Laboratory Service, Pretoria, South Africa.
| | - Linda Bester
- Biomedical Resource Unit, School of Laboratory Medicine and Medical Sciences, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa.
| | - Sabiha Yusuf Essack
- Antimicrobial Research Unit, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa.
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Abreu R, Rodríguez-Álvarez C, Lecuona M, Castro B, González JC, Aguirre-Jaime A, Arias Á. Increased Antimicrobial Resistance of MRSA Strains Isolated from Pigs in Spain between 2009 and 2018. Vet Sci 2019; 6:E38. [PMID: 30987334 PMCID: PMC6632109 DOI: 10.3390/vetsci6020038] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 03/25/2019] [Accepted: 04/02/2019] [Indexed: 11/16/2022] Open
Abstract
The problem of emerging resistant microorganisms such as Methicillin-Resistant Staphylococcus aureus (MRSA) associated to livestock is closely linked to improper use of antimicrobial agents. The aim of this study is to find out the prevalence and characteristics of these strains, as well as their evolution in healthy pigs on the Island of Tenerife, Spain. Between October 2009 and December 2010, 300 pigs from 15 wean-to-finishing farms were screened. Between 1 September 2017 and 31 March 2018, a new sampling was performed collecting 125 nasal swabs from pigs belonging to the same farms and under the same conditions as the previous study. MRSA antibiotic resistant patterns were studied. Results: Prevalence of MRSA isolates was 89.6%. All isolates belonged to Sequence Type 398 (ST398), a livestock related strain. All strains studied were resistant to beta-lactamic non-carbapenemic antibiotics and sensitive to teicoplanin, linezolid, vancomycin, rifampicin, quinupristin-dalfospristin, and mupirocine. Between 2009/2010-2017/2018 a significant increase in resistance to gentamicin, tobramycin, trimethoprim-sulfomethoxazole, clindamycin, Fosfomycin, and tigecycline antibiotics was observed in isolated MRSA strains compared to the previous period. We consider a major control and surveillance program of antibiotic use in veterinary care is needed in order to reduce the presence of MRSA strains in livestock and control this significant multi-resistance increase.
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Affiliation(s)
- Rossana Abreu
- Department of Preventive Medicine and Public Health. Universidad de La Laguna. Campus de Ofra S/N., 38071 Santa Cruz de Tenerife, Spain.
- Microbiology and Infection Control Service of the University Hospital of the Canary Islands (HUC), 38004 Tenerife, Spain.
| | - Cristobalina Rodríguez-Álvarez
- Department of Preventive Medicine and Public Health. Universidad de La Laguna. Campus de Ofra S/N., 38071 Santa Cruz de Tenerife, Spain.
| | - María Lecuona
- Microbiology and Infection Control Service of the University Hospital of the Canary Islands (HUC), 38004 Tenerife, Spain.
| | - Beatriz Castro
- Microbiology and Infection Control Service of the University Hospital of the Canary Islands (HUC), 38004 Tenerife, Spain.
| | - Juan Carlos González
- Canary Islands Health Service, Santa Cruz de Tenerife, 38004 Canary Islands, Spain.
| | - Armando Aguirre-Jaime
- Institute of Care Research, Nurses' Association, 38001 Santa Cruz de Tenerife, Spain.
| | - Ángeles Arias
- Department of Preventive Medicine and Public Health. Universidad de La Laguna. Campus de Ofra S/N., 38071 Santa Cruz de Tenerife, Spain.
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Pirolo M, Gioffrè A, Visaggio D, Gherardi M, Pavia G, Samele P, Ciambrone L, Di Natale R, Spatari G, Casalinuovo F, Visca P. Prevalence, molecular epidemiology, and antimicrobial resistance of methicillin-resistant Staphylococcus aureus from swine in southern Italy. BMC Microbiol 2019; 19:51. [PMID: 30808302 PMCID: PMC6390553 DOI: 10.1186/s12866-019-1422-x] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 02/19/2019] [Indexed: 12/19/2022] Open
Abstract
Background Colonization by livestock-associated MRSA (LA-MRSA) has increasingly been reported in the swine population worldwide. The aim of this study was to assess the prevalence of MRSA nasal carriage in healthy pigs, including the black (Calabrese) breed, from farms in the Calabria Region (Southern Italy). Between January and March 2018, a total of 475 healthy pigs reared in 32 farms were sampled by nasal swabbing. MRSA isolates were characterized by spa, MLST and SCCmec typing, and susceptibility testing to 17 antimicrobials. Results 22 of 32 (66.8%) pig farms resulted positive for MRSA. The prevalence of MRSA was 46.1% (219 MRSA culture-positive out of 475 samples). MRSA colonization was significantly higher in intensive farms and in pigs with a recent or ongoing antimicrobial treatment. All 219 MRSA isolates were assigned to ST398. The most common spa types were t011 (37.0%), t034 (22.4%) and t899 (15.1%). A novel spa type (t18290) was detected in one isolate. An insertion of IS256 in the ST398-specific A07 fragment of the SAPIG2195 gene was detected in 10 out of 81 t011 isolates. Nearly all isolates carried the SCCmec type V element, except 11 isolates that carried the SCCmec type IVc. None of the isolates was positive for the Panton-Valentine leukocidin. All isolates were resistant to tetracycline. High resistance rates were also found for clindamycin (93.1%), trimethoprim/sulfamethoxazole (68.4%), fluoroquinolones (47.9–65.3%) and erythromycin (46.1%). None of the isolates was resistant to vancomycin and fusidic acid. Overall, a multidrug resistant phenotype was observed in 88.6% of isolates. Conclusions We report a high prevalence of MRSA among healthy swine in Southern Italy farms, with higher isolation frequency associated with intensive farming. The epidemiological types identified in our study reflect those reported in other European countries. Our findings underscore the importance of monitoring the evolution of LA-MRSA in pig farms in order to implement control measures and reduce the risk of spread in the animal population. Electronic supplementary material The online version of this article (10.1186/s12866-019-1422-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Mattia Pirolo
- Department of Science, Roma Tre University, Viale G. Marconi 446, 00146, Rome, Italy
| | - Angela Gioffrè
- Department of Medicine, Epidemiology, Workplace and Environmental Hygiene, Lamezia Terme Research Centre, INAIL - National Institute for Insurance against Accidents at Work, Lamezia Terme, Italy
| | - Daniela Visaggio
- Department of Science, Roma Tre University, Viale G. Marconi 446, 00146, Rome, Italy
| | - Monica Gherardi
- Department of Medicine, Epidemiology, Workplace and Environmental Hygiene , Monte Porzio Catone Research Centre, INAIL - National Institute for Insurance against Accidents at Work, Rome, Italy
| | - Grazia Pavia
- Istituto Zooprofilattico Sperimentale del Mezzogiorno, Catanzaro, Italy
| | - Pasquale Samele
- Department of Medicine, Epidemiology, Workplace and Environmental Hygiene, Lamezia Terme Research Centre, INAIL - National Institute for Insurance against Accidents at Work, Lamezia Terme, Italy
| | - Lucia Ciambrone
- Istituto Zooprofilattico Sperimentale del Mezzogiorno, Catanzaro, Italy
| | - Rossella Di Natale
- Department of Biomedical Sciences, Dental, Morphological and Functional Investigations, University of Messina, Messina, Italy
| | - Giovanna Spatari
- Department of Biomedical Sciences, Dental, Morphological and Functional Investigations, University of Messina, Messina, Italy
| | | | - Paolo Visca
- Department of Science, Roma Tre University, Viale G. Marconi 446, 00146, Rome, Italy.
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28
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Moon DC, Jeong SK, Hyun BH, Lim SK. Prevalence and Characteristics of Methicillin-Resistant Staphylococcus aureus Isolates in Pigs and Pig Farmers in Korea. Foodborne Pathog Dis 2018; 16:256-261. [PMID: 30481071 DOI: 10.1089/fpd.2018.2509] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
In this study, we investigated the prevalence and characteristics of methicillin-resistant Staphylococcus aureus (MRSA) isolates from pigs and pig farmers in Korea. A total of 1245 nasal swabs were collected from pigs and farmers at 53 pig farms in nine provinces from 2012 to 2016. The prevalence of MRSA was 7.9% (88/1119) in pigs and 16.7% (21/126) in farmers. Among 119 farmers working on conventional farms, 21 (17.6%) tested positive for MRSA. However, no MRSA was detected in either pigs or farmers at four organic farms. The individual pig-level prevalence of MRSA differed between age groups, with the percentage of positive samples being highest in weaners (17.3%), followed by growers (9.0%), piglets (6.5%), finishers (4.4%), and sows (0%). Two different lineages of MRSA were detected among the 109 isolates from pigs and farmers: (1) livestock-associated types of MRSA belonging to 27 isolates of ST541-t034-V, 24 isolates of ST398-t571-V, 17 isolates of ST398-t034 variant (G420A)-V, and one isolate of ST541-t8588-V; and (2) community-associated types of MRSA belonging to 21 isolates of ST188-t189-IV, 14 isolates of ST72-t324-IV, three isolates of ST72-t664-IV, one isolate of ST72-t148-IV, and one isolate of ST72-t5440-IV. Identical genotypes were detected in both pigs and farmers at six farms. New MRSA clones were isolated from pigs (ST398-t034 (G420A)-V, ST188-t189-IV, and ST398-t571-V) and pig farmers (ST541-t8588-V and ST72-t5440-IV). The prevalence of MRSA was also correlated with antibiotic usage, and the clones showed diversification between pigs and farmers. Ultimately, the increased frequency and diversification of livestock-associated MRSA could be a potential threat to public health in Korea. To our knowledge, this is the first study to report the prevalence and characteristics of MRSA in pigs and pig farmers in Korea.
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Affiliation(s)
- Dong Chan Moon
- 1 Bacterial Disease Division, Animal and Plant Quarantine Agency, Gimcheon-si , Republic of Korea
| | - Soo Kwan Jeong
- 2 Yang Ju Livestock Industry Cooperatives , Gyeonggi, Republic of Korea
| | - Bang-Hun Hyun
- 1 Bacterial Disease Division, Animal and Plant Quarantine Agency, Gimcheon-si , Republic of Korea
| | - Suk-Kyung Lim
- 1 Bacterial Disease Division, Animal and Plant Quarantine Agency, Gimcheon-si , Republic of Korea
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Evaluation of the Pig-Tailed Macaque (Macaca nemestrina) as a Model of Human Staphylococcus aureus Nasal Carriage. Infect Immun 2018; 86:IAI.00043-18. [PMID: 29555678 DOI: 10.1128/iai.00043-18] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 03/12/2018] [Indexed: 12/13/2022] Open
Abstract
Staphylococcus aureus nasal carriage is a common condition affecting both healthy and immunocompromised populations and provides a reservoir for dissemination of potentially infectious strains by casual contact. The factors regulating the onset and duration of nasal S. aureus colonization are mostly unknown, and a human-relevant animal model is needed. Here, we screened 17 pig-tailed macaques (Macaca nemestrina) for S. aureus carriage, and 14 of 17 animals tested positive in the nose at one or both screening sessions (8 weeks apart), while the other 3 animals were negative in the nose but positive in the pharynx at least once. As in humans, S. aureus colonization was densest in the nose, and treatment of the nostrils with mupirocin ointment effectively cleared the nostrils and 6 extranasal body sites. Experimental nasal S. aureus colonization was established with 104 CFU/nostril, and both autologous and nonautologous strains survived over 40 days without any apparent adverse effects. A human nasal S. aureus isolate (strain D579, sequence type 398) was carried in 4 of 6 animals for over 3 weeks. Nostrils that did eradicate experimentally applied S. aureus exhibited neutrophilic innate immunity marked by elevated nasal interleukin-1β (IL-1β), IL-8, and monocyte chemotactic protein 1 levels and a 10-fold decreased IL-1 receptor antagonist/IL-1β ratio within 7 days postinoculation, analogous to the human condition. Taken together, pig-tailed macaques represent a physiological model of human S. aureus nasal carriage that may be utilized for testing natural colonization and decolonization mechanisms as well as novel classes of anti-S. aureus therapeutics.
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30
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Basra P, Alsaadi A, Bernal-Astrain G, O’Sullivan ML, Hazlett B, Clarke LM, Schoenrock A, Pitre S, Wong A. Fitness Tradeoffs of Antibiotic Resistance in Extraintestinal Pathogenic Escherichia coli. Genome Biol Evol 2018; 10:667-679. [PMID: 29432584 PMCID: PMC5817949 DOI: 10.1093/gbe/evy030] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2018] [Indexed: 12/21/2022] Open
Abstract
Evolutionary trade-offs occur when selection on one trait has detrimental effects on other traits. In pathogenic microbes, it has been hypothesized that antibiotic resistance trades off with fitness in the absence of antibiotic. Although studies of single resistance mutations support this hypothesis, it is unclear whether trade-offs are maintained over time, due to compensatory evolution and broader effects of genetic background. Here, we leverage natural variation in 39 extraintestinal clinical isolates of Escherichia coli to assess trade-offs between growth rates and resistance to fluoroquinolone and cephalosporin antibiotics. Whole-genome sequencing identifies a broad range of clinically relevant resistance determinants in these strains. We find evidence for a negative correlation between growth rate and antibiotic resistance, consistent with a persistent trade-off between resistance and growth. However, this relationship is sometimes weak and depends on the environment in which growth rates are measured. Using in vitro selection experiments, we find that compensatory evolution in one environment does not guarantee compensation in other environments. Thus, even in the face of compensatory evolution and other genetic background effects, resistance may be broadly costly, supporting the use of drug restriction protocols to limit the spread of resistance. Furthermore, our study demonstrates the power of using natural variation to study evolutionary trade-offs in microbes.
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Affiliation(s)
- Prabh Basra
- Department of Biology, Carleton University, Ottawa, Ontario, Canada
| | - Ahlam Alsaadi
- Department of Biology, Carleton University, Ottawa, Ontario, Canada
| | | | | | - Bryn Hazlett
- Department of Biology, Carleton University, Ottawa, Ontario, Canada
| | | | - Andrew Schoenrock
- School of Computer Science, Carleton University, Ottawa, Ontario, Canada
- Research Computing Services, Carleton University, Ottawa, Ontario, Canada
| | - Sylvain Pitre
- Research Computing Services, Carleton University, Ottawa, Ontario, Canada
| | - Alex Wong
- Department of Biology, Carleton University, Ottawa, Ontario, Canada
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31
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Qiao M, Ying GG, Singer AC, Zhu YG. Review of antibiotic resistance in China and its environment. ENVIRONMENT INTERNATIONAL 2018; 110:160-172. [PMID: 29107352 DOI: 10.1016/j.envint.2017.10.016] [Citation(s) in RCA: 788] [Impact Index Per Article: 131.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Revised: 10/21/2017] [Accepted: 10/21/2017] [Indexed: 05/21/2023]
Abstract
Antibiotic resistance is a global health crisis linked to increased, and often unrestricted, antibiotic use in humans and animals. As one of the world's largest producers and consumers of antibiotics, China is witness to some of the most acute symptoms of this crisis. Antibiotics and antibiotic resistance genes (ARGs) are widely distributed in surface water, sewage treatment plant effluent, soils and animal wastes. The emergence and increased prevalence of ARGs in the clinic/hospitals, especially carbapenem-resistant gram negative bacteria, has raised the concern of public health officials. It is important to understand the current state of antibiotic use in China and its relationship to ARG prevalence and diversity in the environment. Here we review these relationships and their relevance to antimicrobial resistance (AMR) trends witnessed in the clinical setting. This review highlights the issues of enrichment and dissemination of ARGs in the environment, and also future needs in mitigating the spread of antibiotic resistance in the environment, particularly under the 'planetary health' perspective, i.e., the systems that sustain or threaten human health.
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Affiliation(s)
- Min Qiao
- State Key Lab of Urban and Regional Ecology, Research Center for Eco-Environmental Sciences, Chinese Academy of Sciences, Beijing 100085, China; University of Chinese Academy of Sciences, Beijing 100049, China
| | - Guang-Guo Ying
- State Key Laboratory of Organic Geochemistry, Guangzhou Institute of Geochemistry, Chinese Academy of Sciences, Guangzhou 510640, China
| | - Andrew C Singer
- NERC Centre for Ecology & Hydrology, Wallingford OX10 8BB, United Kingdom
| | - Yong-Guan Zhu
- State Key Lab of Urban and Regional Ecology, Research Center for Eco-Environmental Sciences, Chinese Academy of Sciences, Beijing 100085, China; Key Lab of Urban Environment and Health, Institute of Urban Environment, Chinese Academy of Sciences, Xiamen 361021, China.
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32
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Sun J, Yang M, Sreevatsan S, Bender JB, Singer RS, Knutson TP, Marthaler DG, Davies PR. Longitudinal study of Staphylococcus aureus colonization and infection in a cohort of swine veterinarians in the United States. BMC Infect Dis 2017; 17:690. [PMID: 29052523 PMCID: PMC5649086 DOI: 10.1186/s12879-017-2802-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Accepted: 10/04/2017] [Indexed: 12/04/2022] Open
Abstract
Background People working with pigs are at elevated risk of harboring methicillin resistant S. aureus (MRSA) in their nose, which is attributable to occupational exposure to animals harboring livestock adapted S. aureus. To obtain insight into the biological nature of occupationally related nasal culture positivity, we conducted a longitudinal study of 66 swine veterinarians in the USA. Methods The study cohort resided in 15 US states and worked predominantly with swine. Monthly for 18 months, participants self-collected nasal swabs and completed a survey to report recent exposure to pigs and other animals; the occurrence of work related injuries; and any relevant health events such as skin and soft tissue infections or confirmed staphylococcal infections. Nasal swabs were cultured using selective methods to determine the presence of MRSA and methicillin susceptible S. aureus (MSSA), and isolates were characterized by spa typing and MLST. Results Prevalences of S. aureus (64%, monthly range from 58 to 82%) and MRSA (9.5%; monthly range from 6 to15%) were higher than reported for the US population (30% and 1.5% respectively). Predominant spa types were t034 (ST398, 37%), t002 (ST5, 17%) and t337 (ST9/ST398 13%), a distribution similar to that found in a concurrent study in pigs in the USA. Veterinarians were classified into three groups: Persistent carriers (PC, 52%), Intermittent carriers (IC, 47%) and Non-carriers (NC, 1%). Persistent carriage of a single spa type was observed in 14 (21%) of participants, and paired (first and last) isolates from PC subjects had minor genetic differences. Swabs from PC veterinarians carried higher numbers of S. aureus. Among IC veterinarians, culture positivity was significantly associated with recent contact with pigs. Conclusions Exposure to pigs did not lead to prolonged colonization in most subjects, and the higher numbers of S. aureus in PC subjects suggests that unknown host factors may determine the likelihood of prolonged colonization by S. aureus of livestock origin. Exposure to S. aureus and persistent colonization of swine veterinarians was common but rarely associated with S. aureus disease. Electronic supplementary material The online version of this article (10.1186/s12879-017-2802-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jisun Sun
- Department of Veterinary Population Medicine, University of Minnesota, 385 ASVM, 1988 Fitch Ave, St. Paul, MN, 55108, USA
| | - My Yang
- Department of Veterinary Population Medicine, University of Minnesota, 385 ASVM, 1988 Fitch Ave, St. Paul, MN, 55108, USA
| | - Srinand Sreevatsan
- Department of Veterinary Population Medicine, University of Minnesota, 385 ASVM, 1988 Fitch Ave, St. Paul, MN, 55108, USA
| | - Jeffrey B Bender
- Department of Veterinary Population Medicine, University of Minnesota, 385 ASVM, 1988 Fitch Ave, St. Paul, MN, 55108, USA
| | - Randall S Singer
- Department of Veterinary and Biomedical Sciences, University of Minnesota, St. Paul, MN, 55108, USA
| | - Todd P Knutson
- Department of Veterinary Population Medicine, University of Minnesota, 385 ASVM, 1988 Fitch Ave, St. Paul, MN, 55108, USA
| | - Douglas G Marthaler
- Department of Veterinary Population Medicine, University of Minnesota, 385 ASVM, 1988 Fitch Ave, St. Paul, MN, 55108, USA
| | - Peter R Davies
- Department of Veterinary Population Medicine, University of Minnesota, 385 ASVM, 1988 Fitch Ave, St. Paul, MN, 55108, USA.
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Frequent isolation of methicillin resistant Staphylococcus aureus (MRSA) ST398 among healthy pigs in Portugal. PLoS One 2017; 12:e0175340. [PMID: 28399155 PMCID: PMC5388486 DOI: 10.1371/journal.pone.0175340] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Accepted: 03/26/2017] [Indexed: 11/29/2022] Open
Abstract
Background Although livestock-associated ST398 methicillin-resistant Staphylococcus aureus (MRSA) has been widely reported in different geographic regions, MRSA carriage studies among healthy pigs in Portugal are very limited. Methods and findings In total, 101 swine nasal samples from two Portuguese farms were screened for MRSA. In addition five swine workers (including one veterinary and one engineer) and four household members were nasally screened. The isolates were characterized by spa typing, SCCmec typing and MLST. All isolates were tested for antimicrobial susceptibility, presence of mecA and mecC genes, and virulence determinants. MRSA prevalence in swine was 99% (100/101), 80% (4/5) in swine workers and 25% (1/4) in household members. All isolates belonged to ST398 distributed over two spa types–t011 (57%) and t108 (42%). SCCmec type V was present in most of the isolates (n = 95; 82%) while 21 isolates amplified the mecA gene only and were classified as nontypeable. The majority of the isolates were resistant to tetracycline (100%), clindamycin (97%), erythromycin (96%), chloramphenicol (84%) and gentamycin (69%). Notably, 12% showed resistance to quinupristin-dalfopristin (MICs 3–8 μg/mL). Beta-hemolysin (81%) and gamma-hemolysin (74%) were the unique virulence determinants detected. None of the isolates harboured PVL or mecC gene. Conclusions This study showed a massive occurrence of ST398-MRSA in two independent swine farms, highlighting its establishment among healthy pigs in Portugal.
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Murphy D, Ricci A, Auce Z, Beechinor JG, Bergendahl H, Breathnach R, Bureš J, Duarte Da Silva JP, Hederová J, Hekman P, Ibrahim C, Kozhuharov E, Kulcsár G, Lander Persson E, Lenhardsson JM, Mačiulskis P, Malemis I, Markus-Cizelj L, Michaelidou-Patsia A, Nevalainen M, Pasquali P, Rouby JC, Schefferlie J, Schlumbohm W, Schmit M, Spiteri S, Srčič S, Taban L, Tiirats T, Urbain B, Vestergaard EM, Wachnik-Święcicka A, Weeks J, Zemann B, Allende A, Bolton D, Chemaly M, Fernandez Escamez PS, Girones R, Herman L, Koutsoumanis K, Lindqvist R, Nørrung B, Robertson L, Ru G, Sanaa M, Simmons M, Skandamis P, Snary E, Speybroeck N, Ter Kuile B, Wahlström H, Baptiste K, Catry B, Cocconcelli PS, Davies R, Ducrot C, Friis C, Jungersen G, More S, Muñoz Madero C, Sanders P, Bos M, Kunsagi Z, Torren Edo J, Brozzi R, Candiani D, Guerra B, Liebana E, Stella P, Threlfall J, Jukes H. EMA and EFSA Joint Scientific Opinion on measures to reduce the need to use antimicrobial agents in animal husbandry in the European Union, and the resulting impacts on food safety (RONAFA). EFSA J 2017; 15:e04666. [PMID: 32625259 PMCID: PMC7010070 DOI: 10.2903/j.efsa.2017.4666] [Citation(s) in RCA: 91] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
EFSA and EMA have jointly reviewed measures taken in the EU to reduce the need for and use of antimicrobials in food-producing animals, and the resultant impacts on antimicrobial resistance (AMR). Reduction strategies have been implemented successfully in some Member States. Such strategies include national reduction targets, benchmarking of antimicrobial use, controls on prescribing and restrictions on use of specific critically important antimicrobials, together with improvements to animal husbandry and disease prevention and control measures. Due to the multiplicity of factors contributing to AMR, the impact of any single measure is difficult to quantify, although there is evidence of an association between reduction in antimicrobial use and reduced AMR. To minimise antimicrobial use, a multifaceted integrated approach should be implemented, adapted to local circumstances. Recommended options (non-prioritised) include: development of national strategies; harmonised systems for monitoring antimicrobial use and AMR development; establishing national targets for antimicrobial use reduction; use of on-farm health plans; increasing the responsibility of veterinarians for antimicrobial prescribing; training, education and raising public awareness; increasing the availability of rapid and reliable diagnostics; improving husbandry and management procedures for disease prevention and control; rethinking livestock production systems to reduce inherent disease risk. A limited number of studies provide robust evidence of alternatives to antimicrobials that positively influence health parameters. Possible alternatives include probiotics and prebiotics, competitive exclusion, bacteriophages, immunomodulators, organic acids and teat sealants. Development of a legislative framework that permits the use of specific products as alternatives should be considered. Further research to evaluate the potential of alternative farming systems on reducing AMR is also recommended. Animals suffering from bacterial infections should only be treated with antimicrobials based on veterinary diagnosis and prescription. Options should be reviewed to phase out most preventive use of antimicrobials and to reduce and refine metaphylaxis by applying recognised alternative measures.
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SCC mec typing and antimicrobial resistance of methicillin-resistant Staphylococcus aureus (MRSA) from pigs of Northeast India. Vet Res Commun 2016; 40:117-122. [DOI: 10.1007/s11259-016-9661-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Accepted: 07/18/2016] [Indexed: 11/26/2022]
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