Diffusion of clindamycin-resistant and erythromycin-resistant methicillin-susceptible Staphylococcus aureus (MSSA), potential ST398, in United States Veterans Health Administration Hospitals, 2003-2014
Abstract Background Changing phenotypic profiles of methicillin-susceptible Staphylococcus aureus (MSSA) isolates can indicate the emergence of novel sequence types (ST). The diffusion of MSSA ST can be tracked by combining established genotypic profiles with phenotypic surveillance data. ST398 emer...
| Main Authors: | , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2017-06-01
|
| Series: | Antimicrobial Resistance and Infection Control |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s13756-017-0212-1 |
| _version_ | 1828522840216829952 |
|---|---|
| author | Margaret Carrel Michihiko Goto Marin L. Schweizer Michael Z. David Daniel Livorsi Eli N. Perencevich |
| author_facet | Margaret Carrel Michihiko Goto Marin L. Schweizer Michael Z. David Daniel Livorsi Eli N. Perencevich |
| author_sort | Margaret Carrel |
| collection | DOAJ |
| description | Abstract Background Changing phenotypic profiles of methicillin-susceptible Staphylococcus aureus (MSSA) isolates can indicate the emergence of novel sequence types (ST). The diffusion of MSSA ST can be tracked by combining established genotypic profiles with phenotypic surveillance data. ST398 emerged in New York City (NYC) and exhibits resistance to clindamycin and erythromycin but tetracycline susceptibility (“potential ST398”). Trends of potential ST398 were examined in a national cohort of all Veterans Health Administration patients with MSSA invasive infections during 2003–2014. Methods A retrospective cohort of all patients with MSSA invasive infections, defined as a positive clinical culture from a sterile site, during 2003–2014 was created. Only isolates tested against clindamycin, erythromycin and tetracycline were included. Annual hospital-level proportions of potential ST398 were compared according to facility distance from NYC and region. Results A total of 34,025 patient isolates from 136 VA medical centers met the inclusion criteria. Of those, 4582 (13.5%) met the definition of potential ST398. Potential ST398 increased over the 12-year cohort and diffused outwards from NYC. Incidence Rate Ratios of >1.0 (p < 0.01) reflect increases in potential ST398 over time in hospitals nearer to NYC. Conclusions We observe an increase in the phenotypic profile of potential ST398 MSSA isolates in invasive infections in a national cohort of patients in the US. The increase is not evenly distributed across the US but appears to diffuse outwards from NYC. Novel MSSA strain emergence may have important clinical implications, particularly for the use of clindamycin for suspected S. aureus infections. |
| first_indexed | 2024-12-11T20:16:33Z |
| format | Article |
| id | doaj.art-bf1ee91b93e643e2967604c9f455c046 |
| institution | Directory Open Access Journal |
| issn | 2047-2994 |
| language | English |
| last_indexed | 2024-12-11T20:16:33Z |
| publishDate | 2017-06-01 |
| publisher | BMC |
| record_format | Article |
| series | Antimicrobial Resistance and Infection Control |
| spelling | doaj.art-bf1ee91b93e643e2967604c9f455c0462022-12-22T00:52:11ZengBMCAntimicrobial Resistance and Infection Control2047-29942017-06-01611810.1186/s13756-017-0212-1Diffusion of clindamycin-resistant and erythromycin-resistant methicillin-susceptible Staphylococcus aureus (MSSA), potential ST398, in United States Veterans Health Administration Hospitals, 2003-2014Margaret Carrel0Michihiko Goto1Marin L. Schweizer2Michael Z. David3Daniel Livorsi4Eli N. Perencevich5Department of Geographical & Sustainability Sciences, University of IowaIowa City VA Health Care SystemIowa City VA Health Care SystemDepartment of Medicine, The University of Chicago Biological SciencesIowa City VA Health Care SystemIowa City VA Health Care SystemAbstract Background Changing phenotypic profiles of methicillin-susceptible Staphylococcus aureus (MSSA) isolates can indicate the emergence of novel sequence types (ST). The diffusion of MSSA ST can be tracked by combining established genotypic profiles with phenotypic surveillance data. ST398 emerged in New York City (NYC) and exhibits resistance to clindamycin and erythromycin but tetracycline susceptibility (“potential ST398”). Trends of potential ST398 were examined in a national cohort of all Veterans Health Administration patients with MSSA invasive infections during 2003–2014. Methods A retrospective cohort of all patients with MSSA invasive infections, defined as a positive clinical culture from a sterile site, during 2003–2014 was created. Only isolates tested against clindamycin, erythromycin and tetracycline were included. Annual hospital-level proportions of potential ST398 were compared according to facility distance from NYC and region. Results A total of 34,025 patient isolates from 136 VA medical centers met the inclusion criteria. Of those, 4582 (13.5%) met the definition of potential ST398. Potential ST398 increased over the 12-year cohort and diffused outwards from NYC. Incidence Rate Ratios of >1.0 (p < 0.01) reflect increases in potential ST398 over time in hospitals nearer to NYC. Conclusions We observe an increase in the phenotypic profile of potential ST398 MSSA isolates in invasive infections in a national cohort of patients in the US. The increase is not evenly distributed across the US but appears to diffuse outwards from NYC. Novel MSSA strain emergence may have important clinical implications, particularly for the use of clindamycin for suspected S. aureus infections.http://link.springer.com/article/10.1186/s13756-017-0212-1MSSAST398Spatiotemporal analysisEmergenceDiffusion |
| spellingShingle | Margaret Carrel Michihiko Goto Marin L. Schweizer Michael Z. David Daniel Livorsi Eli N. Perencevich Diffusion of clindamycin-resistant and erythromycin-resistant methicillin-susceptible Staphylococcus aureus (MSSA), potential ST398, in United States Veterans Health Administration Hospitals, 2003-2014 Antimicrobial Resistance and Infection Control MSSA ST398 Spatiotemporal analysis Emergence Diffusion |
| title | Diffusion of clindamycin-resistant and erythromycin-resistant methicillin-susceptible Staphylococcus aureus (MSSA), potential ST398, in United States Veterans Health Administration Hospitals, 2003-2014 |
| title_full | Diffusion of clindamycin-resistant and erythromycin-resistant methicillin-susceptible Staphylococcus aureus (MSSA), potential ST398, in United States Veterans Health Administration Hospitals, 2003-2014 |
| title_fullStr | Diffusion of clindamycin-resistant and erythromycin-resistant methicillin-susceptible Staphylococcus aureus (MSSA), potential ST398, in United States Veterans Health Administration Hospitals, 2003-2014 |
| title_full_unstemmed | Diffusion of clindamycin-resistant and erythromycin-resistant methicillin-susceptible Staphylococcus aureus (MSSA), potential ST398, in United States Veterans Health Administration Hospitals, 2003-2014 |
| title_short | Diffusion of clindamycin-resistant and erythromycin-resistant methicillin-susceptible Staphylococcus aureus (MSSA), potential ST398, in United States Veterans Health Administration Hospitals, 2003-2014 |
| title_sort | diffusion of clindamycin resistant and erythromycin resistant methicillin susceptible staphylococcus aureus mssa potential st398 in united states veterans health administration hospitals 2003 2014 |
| topic | MSSA ST398 Spatiotemporal analysis Emergence Diffusion |
| url | http://link.springer.com/article/10.1186/s13756-017-0212-1 |
| work_keys_str_mv | AT margaretcarrel diffusionofclindamycinresistantanderythromycinresistantmethicillinsusceptiblestaphylococcusaureusmssapotentialst398inunitedstatesveteranshealthadministrationhospitals20032014 AT michihikogoto diffusionofclindamycinresistantanderythromycinresistantmethicillinsusceptiblestaphylococcusaureusmssapotentialst398inunitedstatesveteranshealthadministrationhospitals20032014 AT marinlschweizer diffusionofclindamycinresistantanderythromycinresistantmethicillinsusceptiblestaphylococcusaureusmssapotentialst398inunitedstatesveteranshealthadministrationhospitals20032014 AT michaelzdavid diffusionofclindamycinresistantanderythromycinresistantmethicillinsusceptiblestaphylococcusaureusmssapotentialst398inunitedstatesveteranshealthadministrationhospitals20032014 AT daniellivorsi diffusionofclindamycinresistantanderythromycinresistantmethicillinsusceptiblestaphylococcusaureusmssapotentialst398inunitedstatesveteranshealthadministrationhospitals20032014 AT elinperencevich diffusionofclindamycinresistantanderythromycinresistantmethicillinsusceptiblestaphylococcusaureusmssapotentialst398inunitedstatesveteranshealthadministrationhospitals20032014 |