Literature DB >> 30538503

Which methods are appropriate for the detection of Staphylococcus argenteus and is it worthwhile to distinguish S. argenteus from S. aureus?

René Kaden1, Lars Engstrand2, Hilpi Rautelin1, Cecilia Johansson1.   

Abstract

PURPOSE: To further analyze a clinical isolate originally identified as methicillin-resistant Staphylococcus aureus (MRSA) using whole-genome sequencing and comparative genomics.
MATERIALS AND METHODS: Classical diagnostic methods such as cultivation, biochemical tests, and PCR were supplemented with whole-genome sequencing and comparative genomics, to identify the isolate.
RESULTS: The isolate was phenotypically similar to MRSA. However, the presence of the nuc gene could not be confirmed using PCR, while it was positive for the mecA gene. Whole-genome sequencing correctly identified the isolate as Staphylococcus argenteus. The isolate possessed several resistance genes, such as mecA, blaZ (β-lactam antibiotics) and dfrG (trimethoprim). The nuc gene differed from that of MRSA. Six phylogenetic distinct clusters were identified by average nucleotide identity (ANI) analysis of all available S. argenteus whole-genome sequences. Our isolate, RK308, clustered with those isolated in Europe and Asia.
CONCLUSION: Due to the invasive potential, the multi-drug resistance and the similarity to MRSA, S. argenteus should be included in the MRSA screening. Due to the divergent genome compared to MRSA, new PCR approaches have to be developed to avoid an unnoticed spreading of S. argenteus.

Entities:  

Keywords:  MRSA; Staphylococcus argenteus; Staphylococcus aureus; clinical diagnostics; whole-genome sequencing

Year:  2018        PMID: 30538503      PMCID: PMC6254542          DOI: 10.2147/IDR.S179390

Source DB:  PubMed          Journal:  Infect Drug Resist        ISSN: 1178-6973            Impact factor:   4.003


Introduction

The first outbreaks of methicillin-resistant Staphylococcus aureus (MRSA) were reported from European hospitals in the early 1960s.1 Gradually, MRSA turned out to be one of the main causes of nosocomial infections worldwide but also community-acquired infections are reported frequently. S. aureus clonal complex 75 (CC75) was described as the distinct species Staphylococcus argenteus in 2015.2 S. argenteus usually have the same virulence factors3 and antibiotic resistance genes as S. aureus. The lack of genes for staphyloxanthin production first led to the conclusion that S. argenteus might be less virulent4 since this carotenoid pigment protects against oxidative stress and impairs neutrophil killing of S. aureus.5 This hypothesis could then be refuted through studies showing comparable morbidity and health care-associated infection rates for both species6,7 and furthermore, a recent study reported even increased mortality rates compared to S. aureus.8 Due to the close relationship between S. aureus and S. argenteus, it is difficult to distinguish the species with common diagnostic methods,9 as both species have identical 16S rRNA genes10,11 and also harbor thermostable nuclease genes, such as nuc. Positive mecA assays commonly lead to initial characterization of S. argenteus as MRSA.12 Here, we report how complementation of the classical diagnostic methods for S. aureus and MRSA screening with whole-genome sequencing correctly identified S. argenteus and also provided clues on virulence and antibiotic resistance.

Materials and methods

Bacterial isolates

The bacterial isolate RK308 was originally isolated from a clinical sample sent to the Clinical Microbiology Laboratory at Uppsala University Hospital and was thereafter anonymously analyzed in this study. The type strain of the species S. aureus 1800T and the MRSA CCUG 35601 reference strain were also included for comparison.

Phenotypical analyses

The original clinical sample was selectively enriched overnight at 37°C in MRSA broth (Iso-Sensitest broth, Oxoid, Basingstoke, United Kingdom) with 4 mg/L cefoxitin (Sigma-Aldrich, Steinheim, Germany) and 60 mg/L aztreonam (Bristol-Myers Squibb, Solna, Sweden). A broth volume of 5 µL was transferred to blood and S. aureus ID (SAID) agar plates (bioMérieux, La Balme Les Grottes, France) with a cefoxitin disc (30 µg; Oxoid, Basingstoke, United Kingdom) placed on the agar surface. Bacterial colonies that grew into the antibiotic zone that represented the chromogenic effect of SAID agar, and that had a phenotypical occurrence like that of S. aureus were chosen for further analysis. Matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF, Bruker Daltonik GmbH, Leipzig, Germany) was used to determine the bacterial species.13 Separate colonies were transferred to analysis plates, and 1 µL HCCA (α-Cyano-4-hydroxycinnamic acid) matrix was added to each sample spot to ionize peptides, smaller proteins, triacylglycerols and many other compounds in the initial phase of the analysis. Bruker’s default settings were used for analysis of the obtained spectra. The StaphAurex test (Remel, Lenexa, USA) was applied to confirm suspected S. aureus colonies. Furthermore, heat-inactivated colonies (100°C, 15 minutes) were placed on DNase Agar (Thermo Fisher Scientific, Basingstoke, United Kingdom) plates for confirming extracellular heat-stable DNase activity. The ID32 Staph system (bioMérieux, SA, Marcy l’Etoile, France), commonly used for phenotypical differentiation of 27 staphylococcal species,14 was also applied.

PCR analyses

The DNA from one pure colony was extracted using the Amplicor Respiratory Specimen Preparation Kit (Roche Diagnostics, Mannheim, Germany). The presence or absence of the thermostable nuclease gene (nuc) and the mecA gene was tested by PCR with the primers 5´-TCA GCA AAT GCA TCA CAA ACA G-3´ and 5´-CGT AAA TGC ACT TGC TTC AGG-3´ specific for the nuc gene and 5´-GGG ATC ATA GCG TCA TTA TTC-3´ and 5´-AAC GAT TGT GAC ACG ATA GCC-3´ specific for the mecA gene.15 MRSA broth without bacteria was used as the negative control while the positive control was the MRSA strain CCUG 35601. PCR was performed using a GeneAmp PCR System 9700 (Applied Biosystems, Houston, USA) with initial denaturation at 95°C for 15 minutes and 35 cycles at 94°C for 30 seconds, 55°C for 30 seconds and 72°C for 30 seconds.

Whole genome sequencing

Pure colonies from blood agar plates were transferred to MRSA broth (Oxoid) containing cefoxitin (4 mg/L) and aztreonam (60 mg/L) and incubated overnight at 37°C. DNA extraction was performed from 400 µL of broth with MagNA Pure Compact Nucleic Acid Isolation Kit I (Roche, Mannheim, Germany) according to the manufacturer’s protocol version 12. The libraries for WGS were prepared with a Nextera XT sample preparation kit (Illumina, San Diego, USA). An Illumina HiSeq platform with a 2 × 100 paired end run was used for WGS. The single reads were assembled to contigs with Velvet.16 The paired reads and merging contigs were assembled by Geneious version 8.1.5.17 The average nucleotide identity (ANI), which is based on base by base comparison, to closely related taxa was calculated using the Gegenees software version 2.2.1 with a threshold of 20%.18 The ANI-based phylogenetic tree was constructed in Geneious. The PathoFinder 1.1 database of the Center for Genomic Epidemiology Denmark19 was used to predict the pathogenicity.

Ethical considerations

The isolate studied was obtained as part of the routine hospital laboratory procedure in the identification of infectious agents for the patient. Patient data were kept anonymous for analysis in the research project. As the study only focused on a bacterial isolate, neither written informed consent nor ethical approval was necessary for the study, according to the Swedish act concerning the ethical review of research involving humans, Etikprövningslagen (2003:460).

Results

Identification of RK308 with classical methods

The analyzed isolate, RK308 grew on blood agar plates like S. aureus with beta hemolysis but as whitish colonies, similar to MRSA CCUG 35601 (Figure 1A). On SAID agar plates, the RK308 colonies were clear blue while S. aureus was green (Figure 1). The DNase reaction, as well as the StaphAurex test, were positive for RK308 (Table 1). The analyzed isolate was identified as S. aureus with MALDI-TOF with a score value of 1.916 in the corresponding database (Bruker). ID32 Staph analysis also resulted in determination as S. aureus according to the ID32 Staph manual. To determine if the isolate was an MRSA, a multiplex PCR for amplification of a nuc gene fragment and a mecA gene fragment was applied. The PCR gave a negative signal for nuc but a positive signal for mecA (Table 1), ruling out other nucnegative Staphylococci.
Figure 1

(A) S. argenteus RK308, S. aureus 1800 and MRSA CCUG 35601 on blood agar plates. (B) S. aureus 1800 (green) and S. argenteus RK308 (blue) on SAID agar plate with cefoxitin disc (30 µg).

Abbreviations: MRSA, methicillin-resistant Staphylococcus aureus; SAID, S. aureus ID.

Table 1

Summary of phenotypical characterization of S. argenteus RK308, S. aureus 1800 and MRSA CCUG 35601

S. argenteus RK308S. aureus 1800MRSA CCUG 35601
Colony color on blood agarWhiteYellowWhite
Hemolysis on blood agarBeta*
Colony color on SAID agarBlueGreenBlue/green
Clear zone on DNase agar+++
StaphAurex+NDND
ID32 Staph urease (URE)++
Arginine dehydrogenase (ADH)++
Sucrose (SAC)++
Susceptibility to cefoxitinRSR
VancomycinSNDND
DaptomycinSNDND
MALDI-TOF typingS. aureusS. aureusS. aureus
nuc PCRnd+
mecA PCR+nd+

Notes: +, positive result; −, negative result; R, resistant; S, sensitive; ND, not determined.

, unusual since many S. aureus strains are hemolysin positive

Abbreviations: MALDI-TOF, Matrix-assisted laser desorption/ionization time-of-flight mass spectrometry; MRSA, methicillin-resistant Staphylococcus aureus; SAID, S. aureus ID.

Genomic characterization

The RK308 isolate was whole-genome sequenced. Gap closing was not performed for the RK308 genome since it is not applicable to clinical diagnostic approaches and not essential for the current analysis.20 The final assemblies are available from the NCBI database (BioProject number PRJNA310972, GenBank/EMBL/DDBJ accession number LSFQ00000000). The S. aureus strain Newman (NCBI accession AP009351), which is a representative strain of S. aureus,21 shares 93% identity of the whole genome with S. aureus subspecies anaerobius. These strains showed 74% and 73% identical bases with RK308 in ANI-analysis, which is based on base by base comparison, respectively, while the whole genomes of S. argenteus MSHR1132T and RK308 had 97.2% identical bases. All available S. argenteus whole genome sequences (n=116, May 2018, Table S1) were compared using ANI-analysis. The diversity of the analyzed genomes ranged from 0% to 4.2% (data not shown). Phylogenetic analysis identified six clusters (I-VI, Figure 2), where RK308 clustered with strains mainly isolated in Asia (cluster VI), although its closest relatives seemed to be from Europe (Figure 2).
Figure 2

Phylogenetic ANI-based analysis of S. argenteus whole-genome sequences.

Notes: Symbols indicate geographical location of isolation. The position of isolate RK308 is indicated (#57). Numbers in outer circle refer to isolate numbers from Table S1. Roman numerals correspond to identified clusters I-VI. The dotted line indicates PVL-negative isolates.

Abbreviation: PVL, Panton-Valentine leucocidins.

The spa gene was extracted from the whole genome. The spa-type was t6675 (299-25-17-17-16-16-16). However, the spa gene contained 3 variations in the binding site of the forward primer compared to S. aureus. Furthermore, a low frequent G → A variation was observed in the spa gene. Both thermonucleases of strain Newman were found in RK308. For one of them, amino acid alignment showed high variation in the N-terminal part of the protein (Figure 3A), while the other variant was very similar (Figure 3B).
Figure 3

Amino acid alignment of two heat-stable nucleases of S. aureus Newman and S. argenteus RK308 (A and B).

Notes: Black: identical amino acids; Gray: similar amino acids; White: different amino acid; line: gaps.

All existing 16S rRNA gene sequences of the whole genome were blasted22 to ensure that there was no contamination within the culturing and sequencing procedure. All sequences were determined as S. aureus with an identity of 99%.

Presence of virulence and antibiotic resistance genes

Resistance genes for β-lactams (mecA), penicillins (blaZ) and trimethoprim (dfrG) were detected in the whole genome of RK308. The mecA gene had three-point mutations located outside of the first open reading frame but was otherwise completely functional in vitro. There was no variation within the mecA primer binding sites of the primers listed above. Further analysis of the RK308 staphylococcal cassette chromosome mec (SCCmec) showed that it contained a class A mec gene complex, harboring the mecA, mecR1, and mecI genes and a type 2 (A2B2) ccr gene complex, resulting in a SCCmec type II according to the nomenclature.23 Furthermore, the RK308 SCCmec had almost identical nucleotide sequence to that of MRSA USA300. The mprF gene, involved in daptomycin resistance, was also detected in the whole genome but did not have any of the previously reported amino acid substitutions involved in resistance24 and RK308 did not show resistance to daptomycin in in vitro susceptibility testing (data not shown). Neither did RK308 show vancomycin resistance in vitro, and nor were vancomycin resistance genes found in silico. RK308 was predicted as a human pathogen with a probability of 95.3% and with 100 matched pathogenic families according to the database of the Center for Genomic Epidemiology Denmark.19 Further in silico analyses revealed the presence of the Panton-Valentine leucocidins (PVL, lukF-PV, and lukS-PV) in RK308 and in 83% (96/116) of all the isolates included here. Interestingly, all PVL-negative isolates (isolates #10–29, Table S1), including the S. argenteus type strain MSHR1132, were found in clusters III, IV and V (Figure 2), while all isolates in clusters I, II and VI contained PVL. Other toxin genes, such as gamma-hemolysin (hlg) and exfoliative toxin A (eta) were also found in RK308, while the toxic shock syndrome toxin gene (tsst) and enterotoxins sea-see were not found in RK308.

Discussion

Despite the fact that S. aureus is known to have a clonal population structure,25 a genetic divergence of 26% of the whole genome has been determined. Regarding the mutation frequency that was estimated to an average of 9.2 mutations per year,26 S. argenteus and S. aureus have divided about 41, 000 years ago from the common ancestors. The species determination of S. argenteus is challenging with classical methods,9 and here RK308 was incorrectly identified as S. aureus. The cultivation on SAID agar plates on which the isolate grew with a deviant gray color raised doubts about the correct species identification. The isolate was therefore further analysed with an MRSA-specific multiplex PCR. The mecA gene was detected with PCR while the nuc gene (thermostable nuclease), which is a common marker for S. aureus, gave a negative result. However, two thermostable nuclease genes were found in the genome where the one for which diagnostic primers are used showed many variations between S. aureus strain Newman and S. argenteus RK308, possibly explaining the negative PCR. The positive reaction on DNase plates might, therefore, be due to redundant functions of the two thermostable nuclease genes, as previously reported.27 The variations in the binding site of the forward primer in the spa gene may also lead to difficulties in conventional PCR for spa typing. With the results of WGS, the isolate RK308 could be assigned to the species S. argenteus. While S. aureus is a common species and an important cause of both nosocomial and community-acquired infections, S. argenteus occurs rarely but worldwide (Table S1). However, the real distribution and prevalence of S. argenteus are still unclear. Due to the difficulties in diagnostics, a high number of incorrectly diagnosed S. aureus /MRSA can be suspected if the methods are not appropriate to distinguish between S. aureus and S. argenteus. Thaipadungpanit et al6 reported 4.1% of 246 molecularly typed S. aureus isolates to be S. argenteus. However, the patients might have received the appropriate treatment even if the species identification has been wrong. The results from the in vitro susceptibility testing here showed that RK308 was susceptible to both vancomycin and daptomycin, which would offer good options for treatment. A worse scenario is the application of diagnostic methods specific for S. aureus, like the multiplex PCR described above, which might lead to the unrecognition and further unnoticed spread of S. argenteus. The PCR method described above15 is used by national and reference laboratories worldwide and is considered to be robust and reliable, and a recommended method for detecting MRSA. However, the presence of the complete SCCmec cassette in RK308 might open up new options for screening and detection of S. argenteus in the future. On the basis of the present results, it seems obvious that if both species need to be detected simultaneously, alternative methods have to be applied. There is no consensus, neither national nor international, whether S. argenteus should be included in or excluded from diagnostics of mecA-positive bacteria.28 S. argenteus was previously denoted S. aureus CC75 and all detected MRSA CC75-cases were conclusively clinically treated as MRSA. Conclusively, the updated method for detection of MRSA at the laboratory of the Uppsala University Hospital now also includes S. argenteus and will do so until there is a clear definition in the Communicable Disease Act. Correct identification and separation of the two species will be important for epidemiological studies but might have an even larger impact on clinical practice and treatments as new studies point toward significant mortality rates for S. argenteus combined with sustained susceptibility to several antibiotics.7,8 Although the presence of several resistance genes and the high prevalence of PVL would suggest that S. argenteus is able to cause infections similar to those of S. aureus, the effect of RK308 on human cells remains to be tested. Less is also known about the S. argenteus transmission ways, but several hosts and sources of isolation have been described. According to the metadata belonging to the deposited sequences in the NCBI database,22 the majority of S. argenteus isolates have been isolated from humans but also from various animals, such as gorilla and bats,29,30 and from environmental samples of unknown origin. Although globally distributed, most of the S. argenteus isolates originate from Asia. RK308 clustered among other European and Asian isolates of clonal complex 225031 in the phylogenetic tree.

Conclusion

The differentiation between methicillin-resistant S. argenteus and MRSA is challenging. In this study, all clinical diagnostic methods failed to identify S. argenteus correctly while identification to the species level was obtained by WGS. The S. argenteus isolates studied here, RK308, possessed several virulences and resistance genes usually detected in MRSA, which suggests that S. argenteus could be as virulent as MRSA and should not be left unnoticed. To prevent future spread, appropriate diagnostic methods should be used. S. argenteus genomes used in in silico analyses Note: Origin: Gorilla, Type strain of S. argenteus, Origin: Pig, –; unknown
Table S1

S. argenteus genomes used in in silico analyses

#ClusterIsolateAccession #Origin of the isolateRef.
LocationYear
1IM5219FXVN00000000Denmark20161
2M5224FXWC00000000Denmark20161
3M5200FXVY00000000Denmark20161
4H1955FXWA00000000Denmark20131
5H115100079CCEP00000000UK2
6II3688STDY6125129FQRW00000000Thailand3
73688STDY6125130FQMG00000000Thailand3
83688STDY6125134FQMS00000000Thailand3
9O-9FXVM00000000Denmark20161
10III3688STDY6125128FQME00000000Thailand3
113688STDY6125132FQMJ00000000Thailand3
123688STDY6125135FQMT00000000Thailand3
133688STDY6125143FQNB00000000Thailand3
14SJTU F20124LWAN00000000China20054
15D7903FXVL00000000Denmark20141
16M4185FXVI00000000Denmark20131
173688STDY6125139FQMX00000000Thailand3
18M4528FXWD00000000Denmark20131
193688STDY6125133FQMI00000000Thailand3
20CCUG69385NSBX00000000Sweden20165
21M051_MSHRCCEN00000000Australia
22IV3688STDY6125127FQMH00000000Thailand3
23ABFQMLYLU00000000USA2015
243688STDY6125137FQMV00000000Thailand3
25M260_MSHRCCEF00000000Australia
26BN75aCP015758Gabon20126
27JABA32044V6S1CCEE00000000Fiji
28VDSM_28299PPPZ00000000
29MSHR1132bFR821777Australia20067
30VISJTU F20419LWAO00000000China20124
31SJTU F21285cLWAR00000000China20124
32XNO62CP023076China20148
33XNO106CP025023China20158
343688STDY6125106FQKZ00000000Thailand3
35CCUG69384NSBY00000000Sweden20165
363688STDY6125063FQKD00000000Thailand3
373688STDY6125069FQRB00000000Thailand3
383688STDY6125109FQKX00000000Thailand3
39SJTU F21224LWAQ00000000China20124
403688STDY6125118FQLY00000000Thailand3
41O-5FXVO00000000Denmark20161
423688STDY6125123FQRU00000000Thailand3
433688STDY6125120FQMC00000000Thailand3
443688STDY6125138FQMW00000000Thailand3
453688STDY6125131FQMF00000000Thailand3
46LBSA043CCEM00000000Australia
473688STDY6125111FQLA00000000Thailand3
483688STDY6125125FQLZ00000000Thailand3
493688STDY6125116FQLH00000000Thailand3
50H1864FXVU00000000Denmark20131
51H1826FXWB00000000Denmark20141
52M4146FXVR00000000Denmark20131
53H1540FXVT00000000Denmark20141
54M3040FXVK00000000Denmark20131
55O-2FXWE00000000Denmark20161
56M4611FXWF00000000Denmark20131
57RK308LSFQ010000000Sweden2015This paper
58M4143FXVV00000000Denmark20131
59H2179FXVS00000000Denmark20131
603688STDY6125074FQKI00000000Thailand3
613688STDY6125081FQKM00000000Thailand3
623688STDY6125080FQKL00000000Thailand3
633688STDY6125105FQKT00000000Thailand3
64O-6FXVZ00000000Denmark20161
653688STDY6125114FQRS00000000Thailand3
663688STDY6125140FQMZ00000000Thailand3
673688STDY6125126FQMD00000000Thailand3
68O-1FXVH00000000Denmark20161
693688STDY6125100FQKN00000000Thailand3
703688STDY6125112FQLB00000000Thailand3
713688STDY6125062FQRA00000000Thailand3
72SJTU F21164LWAP00000000China20114
733688STDY6125082FQRG00000000Thailand3
743688STDY6125084FQKQ00000000Thailand3
75O-4FXVQ00000000Denmark20161
763688STDY6125119FQLX00000000Thailand3
773688STDY6125136FQMU00000000Thailand3
783688STDY6125117FQLO00000000Thailand3
791299_SAURJVUX00000000USA20129
80H1604FXVP00000000Denmark20141
813688STDY6125115FQLC00000000Thailand3
823688STDY6125086FQRJ00000000Thailand3
833688STDY6125087FQKP00000000Thailand3
843688STDY6125064FQMN00000000Thailand3
853688STDY6125068FQRD00000000Thailand3
863688STDY6125092FQRN00000000Thailand3
873688STDY6125110FQKY00000000Thailand3
883688STDY6125122FQRT00000000Thailand3
893688STDY6125093FQKW00000000Thailand3
903688STDY6125113FQRR00000000Thailand3
913688STDY6125124FQRV00000000Thailand3
92M4148FXVX00000000Denmark20131
933688STDY6125091FQRM00000000Thailand3
943688STDY6125072FQMR00000000Thailand3
953688STDY6125075FQRF00000000Thailand3
963688STDY6125077FQRH00000000Thailand3
973688STDY6125079FQKG00000000Thailand3
983688STDY6125121FQMA00000000Thailand3
993688STDY6125088FQRK00000000Thailand3
1003688STDY6125090FQKO00000000Thailand3
1013688STDY6125089FQRL00000000Thailand3
102F87619JGHK000000002013
103M21126JGMK000000002013
1043688STDY6125065FQML00000000Thailand3
1053688STDY6125083FQKR00000000Thailand3
1063688STDY6125067FQRC00000000Thailand3
1073688STDY6125066FQMM00000000Thailand3
1083688STDY6125076FQKJ00000000Thailand3
1103688STDY6125070FQMP00000000Thailand3
109O-10FXVJ00000000Denmark20161
1113688STDY6125071FQMQ00000000Thailand3
1123688STDY6125085FQRI00000000Thailand3
1133688STDY6125073FQRE00000000Thailand3
1143688STDY6125108FQLE00000000Thailand3
115O-3FXVW00000000Denmark20161
1163688STDY6125078FQKK00000000Thailand3

Note:

Origin: Gorilla,

Type strain of S. argenteus,

Origin: Pig, –; unknown

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