Highlights
- •S. aureus strains isolated from the hospital environment were more resistant to antibiotics compared to clinical S. aureus isolates.
- •Clinical S. aureus showed more virulence compared to environmental S. aureus.
- •Integrons did not have a major role in the multidrug resistance of S. aureus in both patients and the environment.
- •Methicillin resistance was found in 11% of clinical S. aureus and 60% of environmental S. aureus.
Background
We compared the characteristics of clinical Staphylococcus aureus and S. aureus isolated from environmental surfaces in 3 hospitals.
Methods
Clinical S. aureus isolates were collected from hospitalized patients. Environmental surfaces were sampled
from the rooms of patients infected with S. aureus. After identifying rooms with the target organism, 3-5 high-touch surfaces in patient
care areas were sampled using swabs before room cleaning by environmental services.
S. aureus isolates were subjected to genotyping, antimicrobial susceptibility testing, and
virulence determinant screening. The isolates were analyzed for integron content and
sequences of variable region amplification products.
Results
There were epidemiologically unrelated 79 clinical and 62 environmental S. aureus isolates. Overall, 11.4% of clinical and 59.7% of environmental isolates were methicillin-resistant.
The environmental and clinical S. aureus exhibited very different virulence profiles: 79% of the environmental isolates were
negative for virulence genes compared to 2.5% of clinical isolates (P < .001). Environmental isolates were more resistant to antibiotics compared to clinical
isolates. Class 1 integrons were only detected in 7 of 62 environmental isolates,
of which 3 isolates had integrons with cysteine synthase cassette, 1 had aadA1, and 1 had an unknown cassette.
Conclusion
These data indicate the different characteristics between environmental and clinical
S. aureus, which may reflect different reservoirs from which the 2 groups acquired the strains.
Key Words
Abbreviations:
EN (environmental), CL (clinical)To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to American Journal of Infection ControlAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Airborne Staphylococcus aureus in different environments—a review.Environment Sci Pollution Res. 2019; 26: 34741-34753
- Guidelines for environmental infection control in health-care facilities: recommendations of CDC and the healthcare infection control practices advisory committee (HICPAC).MMWR. 2003; 52 (Update: 2019): 1-48
- Antibiotic Resistance Threats in the United States.US Department of Health and Human Services, Washington, DC, USA2019
- Hemolysins of Staphylococcus aureus—an update on their biology, role in pathogenesis and as targets for anti-virulence therapy.Advanc Infect Dis. 2019; 9: 80-104
- Capsule-negative Staphylococcus aureus induces chronic experimental mastitis in mice.Infect Immun. 2005; 73: 7932-7937
- Staphyloxanthin: a potential target for antivirulence therapy.Infection Drug Resistance. 2019; 12: 2151
- Methicillin resistance reduces the virulence of healthcare-associated methicillin-resistant Staphylococcus aureus by interfering with the agr quorum sensing system.J Infect Dis. 2012; 205: 798-806
- Integron gene cassettes harboring novel variants of d-alanine-d-alanine ligase confer high-level resistance to d-cycloserine.Sci Rep. 2020; 10: 1-16
- Class 1 integron in staphylococci.Mol Biol Rep. 2011; 38: 5261-5279
- Contamination, disinfection, and cross-colonization: are hospital surfaces reservoirs for nosocomial infection?.Clin Infect Dis. 2004; 39: 1182-1189
- Transmission of Staphylococcus aureus between health-care workers, the environment, and patients in an intensive care unit: a longitudinal cohort study based on whole-genome sequencing.Lancet Infect Dis. 2017; 17: 207-214
- The trend of environmental and clinical methicillin-resistant Staphylococcus aureus in a hospital in Taiwan: Impact of USA300.J Microbiol, Immunol Infect. 2022; 55: 241-248
- Widespread environmental contamination associated with patients with diarrhea and methicillin-resistant Staphylococcus aureus colonization of the gastrointestinal tract.Infect Control Hospital Epidemiol. 2007; 28: 1142-1147
- Does improving surface cleaning and disinfection reduce health care-associated infections?.Am J Infect Control. 2013; 41 (S12-S19)
- Bailey & Scott’s Diagnostic Microbiology. Elsevier Health Sciences, St. Louis, Missouri2015
- New quadriplex PCR assay for detection of methicillin and mupirocin resistance and simultaneous discrimination of Staphylococcus aureus from coagulase-negative staphylococci.J Clin Microbiol. 2004; 42: 4947-4955
- Rep-PCR tests for identification of bacteria.EPPO Bull. 2010; 40: 365-368
- Comparison of multilocus variable-number tandem repeat analysis and pulsed-field gel electrophoresis in molecular subtyping of Salmonella enterica serovars Paratyphi A.Diagn Microbiol Infect Dis. 2011; 69: 1-6
- Performance Standards for Antimicrobial Disk Susceptibility Tests.Clinical and Laboratory Standards Institute, Wayne, PA2020
- Novel multiplex PCR assay for characterization and concomitant subtyping of staphylococcal cassette chromosome mec types I to V in methicillin-resistant Staphylococcus aureus.J Clin Microbiol. 2005; 43: 5026-5033
- Genotypic characterization by polymerase chain reaction of Staphylococcus aureus isolates associated with bovine mastitis.Vet Microbiol. 2011; 153: 285-292
- Molecular epidemiology of acquired-metallo-β-lactamase-producing bacteria in Poland.Antimicrob Agents Chemother. 2006; 50: 880-886
- Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria: an international expert proposal for interim standard definitions for acquired resistance.Clin Microbiol Infect. 2012; 18: 268-281
- Prevalence and pattern of antibiotic resistance of Staphylococcus aureus isolated from door handles and other points of contact in public hospitals in Ghana.Antimicrobi Resistance Infect Control. 2017; 6: 1-6
- Isolation of common aerobic bacterial pathogens from the environment of seven hospitals, Ahvaz, Iran.Jundishapur J Microbiol. 2011; 4: 75-82
- The oral cavity revealed as a significant reservoir of Staphylococcus aureus in an acute hospital by extensive patient, healthcare worker and environmental sampling.J Hosp Infect. 2020; 105: 389-396
- New epidemiology of Staphylococcus aureus infection in Asia.Clin Microbiol Infect. 2014; 20: 605-623
- The distribution of pathogenic and toxigenic genes among MRSA and MSSA clinical isolates.Microb Pathog. 2015; 81: 60-66
- MRSA prevalence in European healthcare settings: a review.BMC Infect Dis. 2011; 11: 1-13
- Distribution of bacterial contamination in a teaching hospital in Tehran—A special focus on Staphylococcus aureus.Acta Microbiol Immunol Hung. 2012; 59: 1-11
- Molecular characteristic and virulence gene profiles of community-associated methicillin-resistant Staphylococcus aureus isolates from pediatric patients in Shanghai.China. Front Microbiol. 2016; 7: 1818
- Molecular characterization of community-and healthcare-associated methicillin-resistant Staphylococcus aureus isolates in southern Taiwan.Microb Drug Resist. 2015; 21: 610-621
- Fluoroquinolone-resistant Pseudomonas aeruginosa: assessment of risk factors and clinical impact.Am J Med. 2006; 119 (526. e19-526. e25)
- High genetic diversity of methicillin-susceptible Staphylococcus aureus (MSSA) from humans and animals on livestock farms and presence of SCC mec remnant DNA in MSSA CC398.J Antimicrob Chemother. 2014; 69: 355-362
- Antimicrobial resistance, virulence genes profiling and molecular relatedness of methicillin-resistant Staphylococcus aureus strains isolated from hospitalized patients in Guangdong Province, China.Infect Drug Resistance. 2019; 12: 447
- Association between antimicrobial resistance and virulence in Escherichia coli.Virulence. 2012; 3: 18-28
- The occurrence of type I, II, and III integrons in multi-drug resistance and methicillin-resistant Staphylococcus aureus isolates in Iran.Curr Microbiol. 2020; 77: 1653-1659
- Nosocomial infection caused by class 1 integron-carrying Staphylococcus aureus in a hospital in South China.Clin Microbiol Infect. 2007; 13: 980-984
- A study on class I integrons and antimicrobial resistance among clinical staphylococci isolates from a Turkish hospital.Clin Microbiol. 2014; 61000173
- Role of a cysteine synthase in Staphylococcus aureus.J Bacteriol. 2004; 186: 1579-1590
- Deciphering the interplay between cysteine synthase and thiol cascade proteins in modulating Amphotericin B resistance and survival of Leishmania donovani under oxidative stress.Redox Biol. 2017; 12: 350-366
- Novel insights about class 2 integrons from experimental and genomic epidemiology.Antimicrob Agents Chemother. 2010; 54: 699-706
Article info
Publication history
Published online: December 22, 2022
Publication stage
In Press Journal Pre-ProofFootnotes
Conflicts of Interest: None to report.
Funding: This study was supported by a grant [IR.MUK.REC.1399.162] from Faculty of Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran.
Author contributions: S. Kh. performed the experiments and prepared the manuscript. S.D. designed the search, analyzed the data, and prepared the manuscript. M.A. prepared the manuscript.
Ethics approval and Informed consent: IR.MUK.REC.1399.162, This study was approved by the ethics committee at the Kurdistan University of Medical Sciences. All research was performed in accordance with relevant guidelines/regulations.
Informed consent was obtained from all patients.
Availability of data and materials: All data generated or analyzed during this study are included in this article.
Identification
Copyright
© 2022 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.
