Factors contributing to epidemic MRSA clones replacement in a hospital setting

PLoS One. 2012;7(8):e43153. doi: 10.1371/journal.pone.0043153. Epub 2012 Aug 14.

Abstract

The mechanisms governing the epidemiology dynamics and success determinants of a specific healthcare-associated methicillin-resistant S. aureus (HA-MRSA) clone in hospital settings are still unclear. Important epidemiological changes have occurred in Europe since 2000 that have been related to the appearance of the ST22-IV clone. Between 2006 and 2010, we observed the establishment of the ST22-IV clone displacing the predominant Italian clone, ST228-I, in a large Italian university hospital. To investigate the factors associated with a successful spread of epidemic MRSA clones we studied the biofilm production, the competitive behavior in co-culture, the capacity of invasion of the A549 cells, and the susceptibility to infection in a murine model of acute pneumonia of the two major HA-MRSA clones, ST22-IV and ST228-I. We showed that persistence of ST22-IV is associated with its increased biofilm production and capacity to inhibit the growth of ST228-I in co-culture. Compared to ST228-I, ST22-IV had a significantly higher capacity to invade the A549 cells and a higher virulence in a murine model of acute lung infection causing severe inflammation and determining death in all the mice within 60 hours. On the contrary, ST228-I was associated with mice survival and clearance of the infection. ST22-IV, compared with ST228-I, caused a higher number of persistent, long lasting bacteremia. These data suggest that ST22-IV could have exploited its capacity to i) increase its biofilm production over time, ii) maintain its growth kinetics in the presence of a competitor and iii) be particularly invasive and virulent both in vitro and in vivo, to replace other well-established MRSA clones, becoming the predominant European clone.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Animals
  • Biofilms
  • Cell Line, Tumor
  • Coculture Techniques
  • Cross Infection
  • Hospitals
  • Humans
  • Kinetics
  • Lung / microbiology
  • Methicillin-Resistant Staphylococcus aureus / genetics*
  • Mice
  • Mice, Inbred C57BL
  • Middle Aged
  • Staphylococcal Infections / genetics
  • Staphylococcal Infections / microbiology*
  • Virulence Factors

Substances

  • Virulence Factors

Grants and funding

This study was supported to DMC and A. Bragonzi by Fondazione per la ricerca sulla Fibrosi Cistica (project FFC#9/2010). The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.