Methicillin-resistant Staphylococcus aureus (MRSA) is well known for its epidemicity, with the emergence of new clones on a daily basis. Diversity in the clonal types of MRSA challenges the success of treatment, as different clones respond to different sets of antibiotics. However, the antibiotic susceptibility among the isolates within the same clones is largely unexplored. In a previous study on MRSA epidemiology in Malaysia, we identified six major clonal complexes (ST-239-CC8, ST-1-CC1, ST-188-CC1, ST-22-CC22, ST-7-CC7 and ST-1283-CC8). In the present study, we investigated the antibiotic susceptibility patterns of isolates of different clones. Three hundred and eighty-nine MRSA isolates were subjected to the disc diffusion test, oxacillin minimum inhibitory concentration (MIC) determination and assessment of the distribution of macrolide, lincosamide and streptogramin B (MLS(B)) resistance genes. Thirty-six different antibiotic profiles were observed: 30 (83.3 %) among ST-239, 2 (5.6 %) among ST-1283 and 1 (2.8 %) each for ST-1, ST-7, ST-22 and ST-188. All ST-239 (362, 9 %) isolates were multiple drug-resistant (MDR; resistant to more than three classes of antibiotics) and had oxacillin MICs >256 mg/l. Among the 385 clindamycin-resistant isolates, 375 (96.4 %) illustrated inducible resistance (D-zone-positive), while 10 (2.6 %) showed constitutive resistance. The vast majority of the macrolide-resistant isolates carried the ermA gene (95.1 %), followed by ermC (12.9 %). Diversity in the antibiotic susceptibilities of isolates within the clones emphasises the need for continuous surveillance of MDR strains to prescribe the correct antibiotic rather than empirical treatment. This will likely reduce the emergence of new endemic or epidemic resistant MRSA clones.

译文

耐甲氧西林金黄色葡萄球菌 (MRSA) 以其流行而闻名,每天都有新的克隆出现。MRSA克隆类型的多样性对治疗的成功提出了挑战,因为不同的克隆对不同的抗生素有反应。然而,同一克隆中分离株之间的抗生素敏感性在很大程度上尚未得到探索。在先前的马来西亚MRSA流行病学研究中,我们确定了六个主要的克隆复合物 (ST-239-CC8,ST-1-CC1,ST-188-CC1,ST-22-CC22,ST-7-CC7和ST-1283-CC8)。在本研究中,我们调查了不同克隆分离株的抗生素敏感性模式。对389株MRSA分离株进行了圆盘扩散测试,苯唑西林最低抑制浓度 (MIC) 测定以及评估大环内酯类,林可酰胺和链霉菌素B (MLS(B)) 抗性基因的分布。观察到36种不同的抗生素谱: ST-239中有30种 (83.3%),ST-1283中有2种 (5.6%),ST-1,ST-7,ST-22和ST-188各1种 (2.8%)。所有ST-239 (362、9%) 分离株均具有多重耐药性 (MDR; 对三类以上抗生素耐药),并且苯唑西林mic> 256 mg/l。在385的克林霉素抗性分离株中,375 (96.4%) 表示诱导型抗性 (D区阳性),而10 (2.6%) 表示组成型抗性。绝大多数大环内酯类抗性分离株携带ermA基因 (95.1%),其次是ermC (12.9%)。克隆中分离株的抗生素敏感性多样性强调需要持续监测MDR菌株以开出正确的抗生素而不是经验治疗。这可能会减少新的地方性或抗流行病的MRSA克隆的出现。

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