Clinical Characteristics and Factors Related to Infection with SCCmec Type II and IV Methicillin-Resistant Staphylococcus aureus in a Japanese Secondary Care Facility: A Single-Center Retrospective Study

• Published in: Journal of global antimicrobial resistance. 2022-12, Vol.31, p.355-362
• Main Authors: Nakano, Yuki, Murata, Masayuki, Matsumoto, Yuji, Toyoda, Kazuhiro, Ota, Azusa, Yamasaki, Sho, Otakeno, Hisao, Yokoo, Kenjo, Shimono, Nobuyuki
• Format: Article
• Language: English
• Subjects: Chromosomes; Community-associated (CA) MRSA; East Asian People; Healthcare-associated (HA) MRSA; Humans; methicillin-resistant Staphylococcus aureus (MRSA); Methicillin-Resistant Staphylococcus aureus - genetics; phenol-soluble modulin-mec (psm-mec) gene; psm-mec gene; Retrospective Studies; Secondary Care; staphylococcal cassette chromosome mec (SCCmec); Staphylococcal Infections - epidemiology; Staphylococcus - genetics; Vancomycin - pharmacology; Virulence Factors - genetics; Virulence gene
• ISSN: 2213-7165; 2213-7173
• DOI: 10.1016/j.jgar.2022.11.003

•SCCmec type IV MRSA was prevalent in our hospital, but not as traditionally defined.•Seb-positive SCCmec type II MRSA harbored 89% psm-mec mutations.•SCCmec type IV MRSA harbored sea and cna (83%) but not PVL genes(lukF-PV/lukS-PV).•SCCmec type IV MRSA causes severe conditions and frequent bloodstream infections.•Infection factors were psm-mec mutation (type II MRSA), sea and cna (type IV MRSA). Differences in virulence genes, including psm-mec which is phenol-soluble modulin-mec (PSM-mec) encoding gene, of predominant staphylococcal cassette chromosome mec (SCCmec) types II and IV methicillin-resistant Staphylococcus aureus (MRSA) may contribute to the virulence and clinical features of MRSA in Japan. We aimed to clarify the clinical characteristics and risk factors of infection among SCCmec types II and IV MRSA isolates from a Japanese secondary acute care hospital. We analyzed 58 SCCmec type II and 83 SCCmec type IV MRSA isolates collected from blood, central venous catheter tips, deep or superficial tissues, and sputum. SCCmec type II MRSA risk factors for progression to infection were seb, enterotoxin gene cluster, psm-mec mutation, and vancomycin minimum inhibitory concentrations (MIC) of 1 or 2 mg/L as virulence factors (adjusted odds ratio [aOR]=11.8; 95% confidence interval [CI]: 2.49–77.7; p=0.004); solid tumor was a host factor (aOR=25.9; 95%CI: 3.66–300; p=0.003). SCCmec type IV MRSA risk factors were sea, cna, and vancomycin MIC of 1 or 2 mg/L as virulence factors (aOR=3.14; 95%CI: 1.06–10.6; p=0.049) and intravascular indwelling catheter as a host factors (aOR=3.78; 95%CI: 1.03–14.5; p=0.045). Compared with SCCmec type II, SCCmec type IV MRSA resulted in more frequent bloodstream infections and higher Sequential Organ Failure Assessment scores. We found that factors related to virulence genes and bacteriological and host characteristics are associated with SCCmec types II and IV MRSA infection and severity. These risk factors may be useful criteria for designing infection control programs.