First Report on Multidrug-Resistant Methicillin-Resistant Staphylococcus aureus Isolates in Children Admitted to Tertiary Hospitals in Vietnam
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The extensive distribution of multidrug-resistant (MDR) methicillin-resistant Staphylococcus aureus (MRSA) poses a threat to healthcare worldwide. This study aimed to investigate the MDR and molecular patterns of MRSA isolates in children admitted to the two biggest tertiary care pediatric hospitals in northern and southern Vietnam. A total of 168 MRSA strains were collected to determine antibiotic susceptibility by minimum inhibitory concentration tests. Antibiotic-resistant genes, pulsed-field gel electrophoresis, staphylococcal cassette chromosome mec (SCCmec) typing, and multilocus sequence typing were used for the molecular characterization of MRSA. Among the total strains, the MDR rate (51.8%) was significantly higher in the northern hospital than in the southern hospital (73% vs. 39%, p < 0.0001). The MDR-MRSA with the highest rates were “ciprofloxacin-erythromycin-gentamicintetracyclines” (35.6%), followed by “erythromycin-tetracycline-chloramphenicol” (24.1%), and “ciprofloxacin-erythromycin-gentamicin” (19.5%), showing an accumulative total of 79.3%. The most susceptible antibiotics were rifampicin (100%) and vancomycin (100%), followed by doxycycline (94.0%), meropenem (78.0%), and cefotaxime (75.0%). The SCCmecII strains showed greater resistance to gentamicin, ciprofloxacin, tetracycline, meropenem and cephalosporins compared with the other strains. The SCCmecII strains exhibited the highest rate in the tested genes (aacA/aphD: 55.2%, ermA/B/C: 89.7%, and tetK/M: 82.8%). ST5- SCCmecII was the predominant clone in the northern hospital, whereas SCCmecIVa was more pronounced in the southern hospital. In conclusion, our results raised concerns about the predominant MDR-MRSA strains in the pediatric hospitals in Vietnam. The north–south difference in the antibiotic resistance patterns and genetic structure of MRSA suggests different MRSA origins and various uses of antimicrobial agents between the two regions.
Abstract
The extensive distribution of multidrug-resistant (MDR) methicillin-resistant Staphylococcus aureus (MRSA) poses a threat to healthcare worldwide. This study aimed to investigate the MDR and molecular patterns of MRSA isolates in children admitted to the two biggest tertiary care pediatric hospitals in northern and southern Vietnam. A total of 168 MRSA strains were collected to determine antibiotic susceptibility by minimum inhibitory concentration tests. Antibiotic-resistant genes, pulsed-field gel electrophoresis, staphylococcal cassette chromosome mec (SCCmec) typing, and multilocus sequence typing were used for the molecular characterization of MRSA. Among the total strains, the MDR rate (51.8%) was significantly higher in the northern hospital than in the southern hospital (73% vs. 39%, p < 0.0001). The MDR-MRSA with the highest rates were “ciprofloxacin-erythromycin-gentamicintetracyclines” (35.6%), followed by “erythromycin-tetracycline-chloramphenicol” (24.1%), and “ciprofloxacin-erythromycin-gentamicin” (19.5%), showing an accumulative total of 79.3%. The most susceptible antibiotics were rifampicin (100%) and vancomycin (100%), followed by doxycycline (94.0%), meropenem (78.0%), and cefotaxime (75.0%). The SCCmecII strains showed greater resistance to gentamicin, ciprofloxacin, tetracycline, meropenem and cephalosporins compared with the other strains. The SCCmecII strains exhibited the highest rate in the tested genes (aacA/aphD: 55.2%, ermA/B/C: 89.7%, and tetK/M: 82.8%). ST5- SCCmecII was the predominant clone in the northern hospital, whereas SCCmecIVa was more pronounced in the southern hospital. In conclusion, our results raised concerns about the predominant MDR-MRSA strains in the pediatric hospitals in Vietnam. The north–south difference in the antibiotic resistance patterns and genetic structure of MRSA suggests different MRSA origins and various uses of antimicrobial agents between the two regions.
참고문헌 (44)
- Wertheim HF, "The role of nasal carriage in Staphylococcus aureus infections", Lancet Infect. Dis, 5, pp.751~762 (2005)
- Boucher HW, "Epidemiology of methicillinresistant Staphylococcus aureus", Clin. Infect. Dis, 46, pp.S344~S349 (2008)
- David MZ, "Community-associated methicillinresistant Staphylococcus aureus : epidemiology and clinical consequences of an emerging epidemic", Clin. Microbiol. Rev, 23, pp.616~687 (2010)
- Lee AS, "Methicillin-resistant Staphylococcus aureus", Nat. Rev. Dis. Primers, 4, pp.18033~ (2018)
- Sola C, "Spread of epidemic MRSA-ST5-IV clone encoding PVL as a major cause of community onset staphylococcal infections in Argentinean children", PLoS One, 7, pp.e30487~ (2012)
- Van Nguyen K, "Staphylococcus aureus nasopharyngeal carriage in rural and urban northern Vietnam", Trans. R. Soc. Trop. Med. Hyg, 108, pp.783~790 (2014)
- Ngoc Thi Vu B, "Population structure of colonizing and invasive Staphylococcus aureus strains in northern Vietnam", J. Med. Microbiol, 65, pp.298~305 (2016)
- Dat VQ, "Bacterial bloodstream infections in a tertiary infectious diseases hospital in Northern Vietnam : aetiology, drug resistance, and treatment outcome", BMC Infect. Dis, 17, pp.493~ (2017)
- Song JH, "Spread of methicillin-resistant Staphylococcus aureus between the community and the hospitals in Asian countries : an ANSORP study", J. Antimicrob. Chemother, 66, pp.1061~1069 (2011)
- Tang CT, "An outbreak of severe infections with communityacquired MRSA carrying the Panton-Valentine leukocidin following vaccination", PLoS One, 2, pp.e822~ (2007)
- Enright MC, "Multilocus sequence typing for characterization of methicillin-resistant and methicillin-susceptible clones of Staphylococcus aureus", J. Clin. Microbiol, 38, pp.1008~1015 (2000)
- Oliveira DC, "Multiplex PCR strategy for rapid identification of structural types and variants of the mec element in methicillin-resistant Staphylococcus aureus", Antimicrob. Agents. Chemother, 46, pp.2155~2161 (2002)
- Clinical and Laboratory Standards Institute, "Performance standards for antimicrobial susceptibility testing; 25th informational supplement. CLSI document M100-S26", Clinical and Laboratory Standards Institute, ~ (2016)
- Maes N, "Evaluation of a triplex PCR assay to discriminate Staphylococcus aureus from coagulase-negative Staphylococci and determine methicillin resistance from blood cultures", J. Clin. Microbiol, 40, pp.1514~1517 (2002)
- McClure JA, "Novel multiplex PCR assay for detection of the staphylococcal virulence marker Panton-Valentine leukocidin genes and simultaneous discrimination of methicillinsusceptible from -resistant staphylococci", J. Clin. Microbiol, 44, pp.1141~1144 (2006)
- Klevens RM, "Community-associated methicillinresistant Staphylococcus aureus and healthcare risk factors", Emerg. Infect. Dis, 12, pp.1991~1993 (2006)
- Magiorakos A-P, "Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria : an international expert proposal for interim standard definitions for acquired resistance", Clin. Microbiol. Infect, 18, pp.268~281 (2012)
- David MZ, "Contrasting pediatric and adult methicillin-resistant Staphylococcus aureus isolates", Emerg. Infect. Dis, 12, pp.631~637 (2006)
- Wang L, "Multidrug-resistant clones of community-associated meticillin-resistant Staphylococcus aureus isolated from Chinese children and the resistance genes to clindamycin and mupirocin", J. Med. Microbiol, 61, pp.1240~1247 (2012)
- Strommenger B, "Multiplex PCR assay for simultaneous detection of nine clinically relevant antibiotic resistance genes in Staphylococcus aureus", J. Clin. Microbiol, 41, pp.4089~4094 (2003)
- Milheiriço C, "Multiplex PCR strategy for subtyping the staphylococcal cassette chromosome mec type IV in methicillin-resistant Staphylococcus aureus : ‘SCCmec IV multiplex’", J. Antimicrob. Chemother, 60, pp.42~48 (2007)
- Lee TM, "Molecular characterization of community-and healthcare-associated methicillin resistant Staphylococcus aureus isolates in southern Taiwan", Microb. Drug. Resist, 21, pp.610~621 (2015)
- Oliveira DC, "Secrets of success of a human pathogen : molecular evolution of pandemic clones of meticillin-resistant Staphylococcus aureus", Lancet Infect. Dis, 2, pp.180~189 (2002)
- Harkins CP, "Methicillin-resistant Staphylococcus aureus emerged long before the introduction of methicillin into clinical practice", Genome Biol, 18, pp.130~ (2017)
- Thuy DB, "Hospital-acquired colonization and infections in a Vietnamese intensive care unit", PLoS One, 13, pp.e0203600~ (2018)
- Hiramatsu K, "Methicillin-resistant Staphylococcus aureus clinical strain with reduced vancomycin susceptibility", J. Antimicrob. Chemother, 40, pp.135~136 (1997)
- Kshetry AO, "Minimum inhibitory concentration of vancomycin to methicillin resistant Staphylococcus aureus isolated from different clinical samples at a tertiary care hospital in Nepal", Antimicrob. Resist. Infect. Control, 5, pp.27~ (2016)
- Kaur DC, "Study of antibiotic resistance pattern in methicillin resistant Staphylococcus aureus with special reference to newer antibiotic", J. Glob. Infect. Dis, 7, pp.78~84 (2015)
- Moise PA, "Multicenter evaluation of the clinical outcomes of daptomycin with and without concomitant beta-lactams in patients with Staphylococcus aureus bacteremia and mild to moderate renal impairment", Antimicrob. Agents. Chemother, 57, pp.1192~1200 (2013)
- Hu J, "Reduced vancomycin susceptibility found in methicillinresistant and methicillin-sensitive Staphylococcus aureus clinical isolates in Northeast China", PLoS One, 8, pp.e73300~ (2013)
- Pham DK, "Monitoring antibiotic use and residue in freshwater aquaculture for domestic use in Vietnam", Ecohealth, 12, pp.480~489 (2015)
- Nguyen MP, "How Could Private Healthcare Better Contribute to Healthcare Coverage in Vietnam?", Int, J. Health Policy. Manag, 6, pp.305~308 (2017)
- Thu TA, "Antibiotic use in Vietnamese hospitals : a multicenter point-prevalence study", Am. J. Infect. Control, 40, pp.840~844 (2012)
- Nga do TT, "Antibiotic sales in rural and urban pharmacies in northern Vietnam : an observational study", BMC Pharmacol. Toxicol, 15, pp.6~ (2014)
- Park C, "Two variants of staphylococcal cassette chromosome mec type IVA in community-associated meticillin-resistant Staphylococcus aureus strains in South Korea", J. Med. Microbiol, 58, pp.1314~1321 (2009)
- Higuchi W, "Emergence of the community-acquired methicillin-resistant Staphylococcus aureus USA300 clone in a Japanese child, demonstrating multiple divergent strains in Japan", J. Infect. Chemother, 16, pp.292~297 (2010)
- Tenover FC, "Methicillin-resistant Staphylococcus aureus strain USA300 : origin and epidemiology", J. Antimicrob. Chemother, 64, pp.441~446 (2009)
- Harastani HH, "Molecular characteristics of Staphylococcus aureus isolated from a major hospital in Lebanon", Int. J. Infect. Dis, 19, pp.33~38 (2014)
- Coombs GW, "Evolution and diversity of communityassociated methicillin-resistant Staphylococcus aureus in a geographical region", BMC Microbiol, 11, pp.215~ (2011)
- Ko KS, "Distribution of major genotypes among methicillin-resistant Staphylococcus aureus clones in Asian countries", J. Clin. Microbiol, 43, pp.421~426 (2005)
- Teixeira LA, "Geographic spread of epidemic multiresistant Staphylococcus aureus clone in Brazil", J. Clin. Microbiol, 33, pp.2400~2404 (1995)
- Liu Y, "Molecular evidence for spread of two major methicillinresistant Staphylococcus aureus clones with a unique geographic distribution in Chinese hospitals", Antimicrob. Agents. Chemother, 53, pp.512~518 (2009)
- Samat Muttaqillah N A, "Clonal diversity of methicillin-resistant Staphylococcus aureus in UKM Medical Centre: characterisation by multilocus sequence typing of different SCCmec type representatives", Sains Malaysiana, 44, pp.1315~1323 (2015)
- Li T, "Current status of Staphylococcus aureus infection in a central teaching hospital in Shanghai, China", BMC Microbiol, 13, pp.153~ (2013)