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Gostev V, Sabinova K, Sopova J, Kalinogorskaya O, Sulian O, Chulkova P, Velizhanina M, Pavlova P, Danilov L, Kraeva L, Polev D, Martens E, Sidorenko S. Phenotypic and genomic characteristics of oxacillin-susceptible mecA-positive Staphylococcus aureus, rapid selection of high-level resistance to beta-lactams. Eur J Clin Microbiol Infect Dis 2023; 42:1125-1133. [PMID: 37515660 DOI: 10.1007/s10096-023-04646-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 07/20/2023] [Indexed: 07/31/2023]
Abstract
The aim of this study is to describe the phenotypic and genetic properties of oxacillin-susceptible methicillin-resistant Staphylococcus aureus (OS-MRSA) isolates and their beta-lactam resistant derivatives obtained after selection with oxacillin. A collection of hospital- (HA-) and community-acquired (CA-) MRSA was screened for oxacillin susceptibility. Antibiotic susceptibility testing, population analysis profile (PAP), mecA expression analysis, and whole genome sequencing (WGS) were performed for 60 mecA-positive OS-MRSA isolates. Twelve high-level beta-lactam resistant derivatives selected during PAP were also subjected to WGS. OS-MRSA were more prevalent among CA-MRSA (49/205, 24%) than among HA-MRSA (11/575, 2%). OS-MRSA isolates belonged to twelve sequence types (ST), with a predominance of ST22-t223-SCCmec IVc and ST59-t1950-SCCmec V lineages. OS-MRSA were characterized by mecA promoter mutations at - 33 (C→T) or - 7 (G→T/A) along with PBP2a substitutions (S225R or E246G). The basal and oxacillin-induced levels of mecA expression in OS-MRSA isolates were significantly lower than those in control ST8-HA-MRSA isolates. Most of the OS-MRSA isolates were heteroresistant to oxacillin. High-level beta-lactam resistant OS-MRSA derivatives selected with oxacillin carried mutations in mecA auxiliary factors: relA (metabolism of purines), tyrS, cysS (metabolism of tRNAs), aroK, cysE (metabolism of amino acids and glycolysis). Cefoxitin-based tests demonstrated high specificity for OS-MRSA detection. The highest positive predictive values (PPV > 0.95) were observed for broth microdilution, the VITEK® 2 automatic system, and chromogenic media. Susceptibility testing of CA-MRSA requires special attention due to the high prevalence of difficult-to-detect OS-MRSA among them. Mis-prescription of beta-lactams for the treatment of OS-MRSA may lead to selection of high-level resistance and treatment failures.
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Affiliation(s)
- Vladimir Gostev
- Pediatric Research and Clinical Center for Infectious Diseases, Professor Popov Str. 9, Saint Petersburg, 197022, Russia
- North-Western State Medical University Named After I. I. Mechnikov, Piskarevskij Prospect 47, Saint Petersburg, 195067, Russia
| | - Ksenia Sabinova
- Pediatric Research and Clinical Center for Infectious Diseases, Professor Popov Str. 9, Saint Petersburg, 197022, Russia
| | - Julia Sopova
- Saint Petersburg State University, Universitetskaya Embankment, Saint Petersburg, 7-9, 199034, Russia
- Vavilov Institute of General Genetics, Universitetskaya Embankment 7-9, Saint Petersburg, 199034, Russia
| | - Olga Kalinogorskaya
- Pediatric Research and Clinical Center for Infectious Diseases, Professor Popov Str. 9, Saint Petersburg, 197022, Russia
| | - Ofeliia Sulian
- Pediatric Research and Clinical Center for Infectious Diseases, Professor Popov Str. 9, Saint Petersburg, 197022, Russia
| | - Polina Chulkova
- Pediatric Research and Clinical Center for Infectious Diseases, Professor Popov Str. 9, Saint Petersburg, 197022, Russia
| | - Maria Velizhanina
- Vavilov Institute of General Genetics, Universitetskaya Embankment 7-9, Saint Petersburg, 199034, Russia
- All-Russia Research Institute for Agricultural Microbiology, Podbelsky Chausse 3, Saint Petersburg, Pushkin 8, 196608, Russia
| | - Polina Pavlova
- Pediatric Research and Clinical Center for Infectious Diseases, Professor Popov Str. 9, Saint Petersburg, 197022, Russia
- Saint Petersburg State University, Universitetskaya Embankment, Saint Petersburg, 7-9, 199034, Russia
| | - Lavrentii Danilov
- Saint Petersburg State University, Universitetskaya Embankment, Saint Petersburg, 7-9, 199034, Russia
| | - Lyudmila Kraeva
- Saint Petersburg Pasteur Institute, Mira Str.14, Saint Petersburg, 197101, Russia
| | - Dmitrii Polev
- Saint Petersburg Pasteur Institute, Mira Str.14, Saint Petersburg, 197101, Russia
| | - Elvira Martens
- Pediatric Research and Clinical Center for Infectious Diseases, Professor Popov Str. 9, Saint Petersburg, 197022, Russia
- North-Western State Medical University Named After I. I. Mechnikov, Piskarevskij Prospect 47, Saint Petersburg, 195067, Russia
| | - Sergey Sidorenko
- Pediatric Research and Clinical Center for Infectious Diseases, Professor Popov Str. 9, Saint Petersburg, 197022, Russia.
- North-Western State Medical University Named After I. I. Mechnikov, Piskarevskij Prospect 47, Saint Petersburg, 195067, Russia.
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