Shinji Ogihara1, Osamu Inoue2, Takaya Yamagami3, Keita Yanagimoto4, Kousei Uematsu5, Yoshiko Hisada6, Takashi Uchida7, Masato Ohta8, Katsue Suzuki-Inoue9. 1. Department of Clinical Laboratory, University of Yamanashi Hospital, 1110, Shimokato, Chuo-shi, Yamanashi, 409-3898, Japan; Division of Infection Control and Prevention, University of Yamanashi Hospital, 1110, Shimokato, Chuo-shi, Yamanashi, 409-3898, Japan; Department of Clinical and Laboratory Medicine, Faculty of Medicine, University of Yamanashi, 1110, Shimokato, Chuo-shi, Yamanashi, 409-3898, Japan. Electronic address: ogiharas@yamanashi.ac.jp. 2. Division of Infection Control and Prevention, University of Yamanashi Hospital, 1110, Shimokato, Chuo-shi, Yamanashi, 409-3898, Japan. Electronic address: oinoue@yamanashi.ac.jp. 3. Department of Microbiology, Yamanashi Institute of Public Health and Environment, 1-7-31, Fujimi, Kofu-shi, Yamanashi, 400-0027, Japan. Electronic address: yamagami-yjz@pref.yamanashi.lg.jp. 4. Department of Microbiology, Yamanashi Institute of Public Health and Environment, 1-7-31, Fujimi, Kofu-shi, Yamanashi, 400-0027, Japan. Electronic address: yanagimoto-amvs@pref.yamanashi.lg.jp. 5. Department of Microbiology, Yamanashi Institute of Public Health and Environment, 1-7-31, Fujimi, Kofu-shi, Yamanashi, 400-0027, Japan. Electronic address: uematsu-syy@pref.yamanashi.lg.jp. 6. Department of Microbiology, Yamanashi Institute of Public Health and Environment, 1-7-31, Fujimi, Kofu-shi, Yamanashi, 400-0027, Japan. Electronic address: hisada-tvj@pref.yamanashi.lg.jp. 7. Department of Clinical Laboratory, University of Yamanashi Hospital, 1110, Shimokato, Chuo-shi, Yamanashi, 409-3898, Japan; Division of Infection Control and Prevention, University of Yamanashi Hospital, 1110, Shimokato, Chuo-shi, Yamanashi, 409-3898, Japan. Electronic address: tuchida@yamanashi.ac.jp. 8. Department of Clinical Laboratory, University of Yamanashi Hospital, 1110, Shimokato, Chuo-shi, Yamanashi, 409-3898, Japan. Electronic address: mohta@yamanashi.ac.jp. 9. Department of Clinical Laboratory, University of Yamanashi Hospital, 1110, Shimokato, Chuo-shi, Yamanashi, 409-3898, Japan; Department of Clinical and Laboratory Medicine, Faculty of Medicine, University of Yamanashi, 1110, Shimokato, Chuo-shi, Yamanashi, 409-3898, Japan. Electronic address: katsuei@yamanashi.ac.jp.
Abstract
INTRODUCTION: USA300 is the most common community-acquired methicillin-resistant Staphylococcus aureus (MRSA) strain. Sequence type (ST) 764 MRSA is a new local variant of the ST 5 lineage. The objective of this study was to determine the clinical characteristics of USA300 and ST 764 infections among outpatients in Japan. METHODS: We obtained MRSA isolates from 132 outpatients who visited our hospital from January 2016 to December 2017 and compared USA300 infection group to ST 764 infection group. Molecular analysis, including that of various toxins and other virulence factors, of the MRSA isolates were performed. In particular, we investigated the relationships among PCR-based open reading frame typing (POT) scores, MRSA clones, and virulence factors. RESULTS: Twenty-seven USA300 isolates (20.5%) and 16 ST 764 isolates (12.1%) were identified. Although USA300 and ST 764 had lower rates of risk factors, their infection rates were higher. USA300-infected patients had higher rates of deep skin and soft tissue infections compared with the non-USA300 CA-MRSA-infected patients. Notably, the USA300 and ST 764 isolates had unique POT scores. CONCLUSIONS: Our results indicated that USA300 MRSA was spreading in an area 120 km west of Tokyo, Japan. We observed multiple cases of ST 764 MRSA infection, raising concerns about the antimicrobial resistance of ST 764, as it limits the choices of antibiotics to treat infection. The POT score can predict the presence of toxins and virulence factors, as well as the clone identity of MRSA with high accuracy.
INTRODUCTION:USA300 is the most common community-acquired methicillin-resistant Staphylococcus aureus (MRSA) strain. Sequence type (ST) 764 MRSA is a new local variant of the ST 5 lineage. The objective of this study was to determine the clinical characteristics of USA300 and ST 764 infections among outpatients in Japan. METHODS: We obtained MRSA isolates from 132 outpatients who visited our hospital from January 2016 to December 2017 and compared USA300infection group to ST 764 infection group. Molecular analysis, including that of various toxins and other virulence factors, of the MRSA isolates were performed. In particular, we investigated the relationships among PCR-based open reading frame typing (POT) scores, MRSA clones, and virulence factors. RESULTS: Twenty-seven USA300 isolates (20.5%) and 16 ST 764 isolates (12.1%) were identified. Although USA300 and ST 764 had lower rates of risk factors, their infection rates were higher. USA300-infectedpatients had higher rates of deep skin and soft tissue infections compared with the non-USA300CA-MRSA-infectedpatients. Notably, the USA300 and ST 764 isolates had unique POT scores. CONCLUSIONS: Our results indicated that USA300 MRSA was spreading in an area 120 km west of Tokyo, Japan. We observed multiple cases of ST 764 MRSA infection, raising concerns about the antimicrobial resistance of ST 764, as it limits the choices of antibiotics to treat infection. The POT score can predict the presence of toxins and virulence factors, as well as the clone identity of MRSA with high accuracy.