An emerging Panton–Valentine leukocidin-positive CC5-meticillin-resistant Staphylococcus aureus-IVc clone recovered from hospital and community settings over a 17-year period from 12 countries investigated by whole-genome sequencing

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  • B. K. Aloba
  • P. M. Kinnevey
  • S. Monecke
  • G. I. Brennan
  • B. O'Connell
  • A. Blomfeldt
  • B. A. McManus
  • W. Schneider-Brachert
  • J. Tkadlec
  • R. Ehricht
  • A. Senok
  • Bartels, Mette Damkjær
  • D. C. Coleman

Background: A novel Panton–Valentine leukocidin (PVL)-positive meticillin-resistant Staphylococcus aureus (MRSA) clonal complex (CC)5-MRSA-IVc (‘Sri Lankan’ clone) was recently described from Sri Lanka. Similar isolates caused a recent Irish hospital outbreak. Aim: To investigate the international dissemination and diversity of PVL-positive CC5-MRSA-IVc isolates from hospital and community settings using whole-genome sequencing (WGS). Methods: Core-genome single nucleotide polymorphism (cgSNP) analysis, core-genome multi-locus sequence typing (cgMLST) and microarray-based detection of antimicrobial-resistance and virulence genes were used to investigate PVL-positive CC5-MRSA-IVc (N = 214 including 46 ‘Sri Lankan’ clone) from hospital and community settings in 12 countries over 17 years. Comparators included 29 PVL-positive and 23 PVL-negative CC5/ST5-MRSA-I/II/IVa/IVc/IVg/V. Results: Maximum-likelihood cgSNP analysis grouped 209/214 (97.7%) CC5-MRSA-IVc into Clade I; average of 110 cgSNPs between isolates. Clade III contained the five remaining CC5-MRSA-IVc; average of 92 cgSNPs between isolates. Clade II contained seven PVL-positive CC5-MRSA-IVa comparators, whereas the remaining 45 comparators formed an outlier group. Minimum-spanning cgMLST analysis revealed a comparably low average of 57 allelic differences between all CC5/ST5-MRSA-IVc. All 214 CC5/ST5-MRSA-IVc were identified as ‘Sri Lankan’ clone, predominantly spa type t002 (186/214) with low population diversity and harboured a similar range of virulence genes and variable antimicrobial-resistance genes. All 214 Sri Lankan clone isolates and Clade II comparators harboured a 9616-bp chromosomal PVL-encoding phage remnant, suggesting both arose from a PVL-positive meticillin-susceptible ancestor. Over half of Sri Lankan clone isolates were from infections (142/214), and where detailed metadata were available (168/214), most were community associated (85/168). Conclusions: Stable chromosomal retention of pvl may facilitate Sri-Lankan clone dissemination.

OriginalsprogEngelsk
TidsskriftJournal of Hospital Infection
Vol/bind132
Sider (fra-til)8-19
Antal sider12
ISSN0195-6701
DOI
StatusUdgivet - feb. 2023

Bibliografisk note

Funding Information:
This work was primarily supported by Dublin Dental University Hospital Microbiology Research Unit. This work was primarily supported by Dublin Dental University Hospital Microbiology Research Unit grant 9512 (D. Coleman). Jan Tkadlec (Prague) was supported by the National Institute for Virology and Bacteriology project no. LX22NPO5103 (Program Exceles, NextGenerationEU).

Funding Information:
The authors wish to acknowledge the support of the staff of the Irish National MRSA Reference Laboratory (NMRSARL), the staff of the referring hospitals who submitted isolates for investigation as well as Elke Müller and Annett Reissig (Jena) for performing array experiments identifying suspect isolates. We thank Edet Udo (Kuwait), Bo Söderquist (Sweden) Anne Tristran (Lyon) for providing some isolates for investigation.

Publisher Copyright:
© 2022 The Author(s)

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