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. 2021 Feb 9:12:623108.
doi: 10.3389/fmicb.2021.623108. eCollection 2021.

Prevalence and Genetic Characteristics of Staphylococcus aureus CC398 Isolates From Invasive Infections in Spanish Hospitals, Focusing on the Livestock-Independent CC398-MSSA Clade

Olouwafemi Mistourath Mama  1 , Carmen Aspiroz  2 , Laura Ruiz-Ripa  1 , Sara Ceballos  1 , Maria Iñiguez-Barrio  1 , Emilia Cercenado  3 , José Manuel Azcona  4 , Lorena López-Cerero  5 , Cristina Seral  6 , Ana Isabel López-Calleja  7 , Alba Belles-Belles  8 , Pilar Berdonces  9 , María Siller  10 , Myriam Zarazaga  1 , Carmen Torres  1 ; Study Group of clinical S. aureus CC398
Affiliations

Prevalence and Genetic Characteristics of Staphylococcus aureus CC398 Isolates From Invasive Infections in Spanish Hospitals, Focusing on the Livestock-Independent CC398-MSSA Clade

Olouwafemi Mistourath Mama et al. Front Microbiol. .

Abstract

Background: Livestock-associated (LA)-CC398-MRSA is closely related to pigs, being unfrequently detected in human invasive infections. CC398-MSSA is emerging in human invasive infections in some countries, but genetic and epidemiological characteristics are still scarcely reported.

Objectives: To determine the prevalence of Staphylococcus aureus (SA) CC398, both MRSA and MSSA, among blood cultures SA isolates recovered in Spanish hospitals located in regions with different pig-farming densities (PD) and characterize the recovered isolates.

Methods: One thousand twenty-two SA isolates (761 MSSA, 261 MRSA) recovered from blood cultures during 6-12 months in 17 Spanish hospitals (2018-2019) were studied. CC398 lineage identification, detection of spa-types, and antibiotic resistance, virulence and human immune evasion cluster (IEC) genes were analyzed by PCR/sequencing.

Results: Forty-four CC398-MSSA isolates (4.3% of SA; 5.8% of MSSA) and 10 CC398-MRSA isolates (1% of SA; 3.8% of MRSA) were detected. Eleven spa-types were found among the CC398-MSSA isolates with t571 and t1451 the most frequent spa-types detected (75%). Most of CC398-MSSA isolates were Immune-Evasion-Cluster (IEC)-positive (88.6%), tetracycline-susceptible (95.5%) and erythromycin/clindamycin-inducible-resistant/erm(T)-positive (75%). No statistical significance was detected when the CC398-MSSA/MSSA rate was correlated to PD (pigs/km2) (p = 0.108). On the contrary, CC398-MRSA isolates were all IEC-negative, predominately spa-t011 (70%), and the CC398-MRSA/MRSA rate was significantly associated to PD (p < 0.005).

Conclusion: CC398-MSSA is an emerging clade in invasive infections in Spanish hospitals. CC398-MRSA (mostly t011) and CC398-MSSA (mostly t571 and t1451) show important differences, possibly suggesting divergent steps in host-adaptation evolutionary processes. While CC398-MRSA is livestock-associated (lacking IEC-system), CC398-MSSA seems to be mostly livestock-independent, carrying human-adaptation markers.

Keywords: CC398; LA-MRSA; MSSA; Spain; bacteremia; erm(T); t1451; t571.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

FIGURE 1
FIGURE 1
Map of Spain, highlighting the different regions in which are located the hospitals included in this study and the pig density of the regions. Code for hospitals (H). H1, H. Universitario Arnau Vilanova; H2, H. San Jorge; H3, H. Barbastro; H4, H. Universitari de Vic; H5, H. Universitario Miguel Servet; H6, H. Universitario Lozano Blesa; H7, H. Royo Villanova; H8, Complejo Hospitalario de Navarra; H9, Clínica Universitaria de Navarra; H10, H. Universitario Virgen Macarena; H11, H. Universitario de Burgos; H12, H. San Pedro; H13, H. de Galdakao; H14, H. Universitario de Álava; H15, H. Universitario de Donostia; H16, H. Universitario Gregorio Marañón; H17, H. Universitario Marqués de Valdecilla. ■ Regions with low pig density (0–10 pigs/km2): Bizcaia (H13); Araba (H14); Gipuzcoa (H15); Madrid (H16); Cantabria (H17). ■ Regions with medium pig density (11–50 pigs/km2): Sevilla (H10); Burgos (H11); La Rioja (H12). ■ Regions with high pig density (51–150 pigs/km2): Navarra (H8; H9). ■ Regions with very high pig density (>150 pigs/km2): Lleida (H1); Huesca (H2; H3); Barcelona (H4); Zaragoza (H5; H6; H7).
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