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Infection. 2019 Feb 22. doi: 10.1007/s15010-019-01282-w. [Epub ahead of print]

Genomic epidemiology of MRSA infection and colonization isolates among military trainees with skin and soft tissue infection.

Author information

1
Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA. emillar@idcrp.org.
2
Henry M. Jackson Foundation for the Advancement of Military Medicine, Rockville, MD, USA. emillar@idcrp.org.
3
Leidos, Reston, VA, USA.
4
Naval Medical Research Center, Biological Defense Research Directorate, Fort Detrick, MD, USA.
5
Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA.
6
Henry M. Jackson Foundation for the Advancement of Military Medicine, Rockville, MD, USA.
7
University of Toledo College of Medicine and Life Sciences, Toledo, OH, USA.
8
Walter Reed Army Institute of Research, Silver Spring, MD, USA.
9
Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA.

Abstract

PURPOSE:

Individuals with methicillin-resistant Staphylococcus aureus (MRSA) skin and soft tissue infection (SSTI) can be simultaneously colonized with MRSA on multiple body sites. Using whole genome sequencing (WGS), the intrahost relatedness of MRSA colonization and infection isolates was investigated.

METHODS:

In the context of a prospective case-control study of SSTI, we analyzed colonization and infection isolates from US Army Infantry trainees with purulent infection due to MRSA. At the time of clinical presentation for SSTI, culture swabs were obtained from the infection site, as well as from the patient's nasal, oral, inguinal, and perianal regions. S. aureus culture and susceptibility was performed by standard methods. DNA from MRSA isolates was extracted and libraries were produced. Sequences were generated on an Illumina MiSeq, sequence reads were assembled, and single nucleotide variant (SNV) data were analyzed.

RESULTS:

Of 74 trainees with MRSA SSTI, 19 (25.7%) were colonized with MRSA. Ten (52.6%) were colonized on more than one body site. Colonization frequency by anatomic site was as follows: inguinal region (33%), nasal region (30%), perianal region (22%), and oral region (14%). A total of 36 MRSA colonization isolates were characterized. The intrahost median number of SNVs between infection and colonization isolates was 17. Among trainees with recurrent MRSA SSTI, limited intrahost diversity suggests that persistent colonization is a major contributor to recurrence risk.

CONCLUSIONS:

Among military trainees with MRSA SSTI, genomic characterization of infection and colonization isolates revealed a high degree of strain relatedness. Single acquisition events may account for MRSA colonization and infection in this population.

KEYWORDS:

Colonization; Genomics; Methicillin-resistant Staphylococcus aureus (MRSA); Military; Skin and soft tissue infection; Whole genome sequencing

PMID:
30796628
DOI:
10.1007/s15010-019-01282-w

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