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Multicenter Study
. 2021 Sep 15;76(10):2519-2527.
doi: 10.1093/jac/dkab208.

Penicillin susceptibility among invasive MSSA infections: a multicentre study in 16 Spanish hospitals

Olouwafemi Mistourath Mama  1 , Carmen Aspiroz  2 , Carmen Lozano  1 , Laura Ruiz-Ripa  1 , José Manuel Azcona  3 , Cristina Seral  4 , Emilia Cercenado  5 , Lorena López-Cerero  6 , Pilar Palacian  7 , Alba Belles-Belles  8 , Pilar Berdonces  9 , María Siller  10 , Amaia Aguirre-Quiñonero  11 , Myriam Zarazaga  1 , Carmen Torres  1 ; Spanish Study Group of Clinical S. aureus CC398
Collaborators, Affiliations
Multicenter Study

Penicillin susceptibility among invasive MSSA infections: a multicentre study in 16 Spanish hospitals

Olouwafemi Mistourath Mama et al. J Antimicrob Chemother. .

Abstract

Objectives: To determine the prevalence of penicillin susceptibility among MSSA causing bloodstream infections (BSIs) in 16 Spanish hospitals and to characterize the penicillin-susceptible MSSA (MSSA-PENS) isolates.

Methods: A total of 1011 Staphylococcus aureus isolates were collected from blood cultures in 16 Spanish hospitals during 2018-19 (6-12 months) and their susceptibility to 18 antimicrobials was determined. The MSSA-PENS isolates were selected and examined by PCR to determine the presence of the blaZ gene, other resistance genes and the genes lukF/lukS-PV, eta, etb and tst. The immune evasion cluster (IEC) type was also analysed. All the MSSA-PENS isolates were submitted to S. aureus protein A (spa) typing and the clonal complexes (CCs) were assigned according to their spa type.

Results: The prevalence of MSSA was 74.6% (754/1011) and 14.9% (151/1011) were MSSA-PENS-blaZnegative. MSSA-PENS-blaZnegative isolates (n = 151) were ascribed to 88 spa types and 11 CCs. The most frequent CCs were CC5 (35/151) and CC398 (25/151), with t002-CC5 and t571-CC398 being the most common lineages. Pan-susceptibility was identified in 117 of the 151 MSSA-PENS-blaZnegative isolates (77.5%). In the remaining isolates, erythromycin and clindamycin resistance was the most frequent resistance found, although tobramycin, ciprofloxacin, fusidic acid, mupirocin and/or tetracycline resistance was also detected. Thirty-eight MSSA-PENS-blaZnegative isolates were IEC negative and four isolates were Panton-Valentine leucocidin ('PVL') positive.

Conclusions: A high penicillin susceptibility rate was detected among MSSA, opening therapeutic opportunities for BSIs. The emergence of new successful MSSA-PENS clones could be responsible for these data. The detection among MSSA-PENS-blaZnegative isolates of the clonal lineage CC398 or the absence of an IEC raises questions about their possible animal origin, requiring further analysis.

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