皮膚科外来患者由来MRSA 株に見られる 新規MRSA クローンの出現状況
我が国の市中に拡がるメチシリン耐性黄色ブドウ球菌の特徴を明らかにする目的で，2009 年2 月から2012 年9 月に順天堂大学附属4 病院の皮膚科外来患者の検査材料から分離されたmethicillin-resistant Staphylococcus aureus（MRSA）54 株のStaphylococcal cassette chromosome mec（SCCmec）のタイプとMulti Locus Sequence Typing（MLST）を決定した．加えて4 種の毒素遺伝子の保有を検討した． 10 の染色体タイプ（Clonal Complex）と12 のSCCmec タイプが存在...
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| Published in | 感染症学雑誌 Vol. 88; no. 6; pp. 840 - 848 |
|---|---|
| Main Authors | , , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
一般社団法人 日本感染症学会
20.11.2014
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| Online Access | Get full text |
| ISSN | 0387-5911 1884-569X |
| DOI | 10.11150/kansenshogakuzasshi.88.840 |
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| Abstract | 我が国の市中に拡がるメチシリン耐性黄色ブドウ球菌の特徴を明らかにする目的で，2009 年2 月から2012 年9 月に順天堂大学附属4 病院の皮膚科外来患者の検査材料から分離されたmethicillin-resistant Staphylococcus aureus（MRSA）54 株のStaphylococcal cassette chromosome mec（SCCmec）のタイプとMulti Locus Sequence Typing（MLST）を決定した．加えて4 種の毒素遺伝子の保有を検討した． 10 の染色体タイプ（Clonal Complex）と12 のSCCmec タイプが存在し，この二つの組み合わせで定義されるMRSA クローンは15 種類以上あった．最も多く検出されたのはClonal Complex（CC）5-typeIIa SCCmec 株（16 株）であった．我が国の院内感染事例から分離される株の多くが毒素性ショック症候群毒素遺伝子（toxic shock syndrome toxin gene ; tst）陽性のCC5-typeIIa SCCmec 株であるのに比べ，今回の供試菌株中ではtst 陽性のCC5-typeIIa SCCmec 株はわずか2 株で，他はtst 陰性であった．CC5 株以外が38 株（70.4％）あった．その中ではCC8 株が12 株と多かったが，tst 陽性CC8-typeIVl SCCmec 株9 株，Panton-Valentine Leukocidin（PVL）遺伝子（lukS，F-PV）を保有するCC8-typeIVa SCCmec 株1 株など，既知の毒素遺伝子保有株が10 株を占めた．続いて多かったのはとびひと関連するクローンでCC89-typeV SCCmec 株およびCC89-typeIIb SCCmec 株では，6 株中5 株および5 株中2 株がb 型表皮剥奪性毒素遺伝子（exofoliative toxin b ; etb）を保有していた．CC121-typeV SCCmec 株は，2 株中2 株がa 型表皮剥奪性毒素遺伝子（exofoliative toxin a ; eta）を保有していた．他にCC1-typeIVa SCCmec 株，CC8-typeI SCCmec 株，CC81-typeIVg SCCmec 株，CC97-typeIVc SCCmec 株，CC89-typeIVa SCCmec 株，CC91-typeIVa SCCmec 株，CC45-typeIIn SCCmec 株（サブタイプの決まらない株），CC59-typeIVg SCCmec 株，及び本研究で見いだされた新規サブタイプのCC8-typeIVm SCCmec, CC89-SCCmec 未同定株が存在し，多様なMRSA クローンが出現している状況が本検討で明らかにされた． |
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| AbstractList | 我が国の市中に拡がるメチシリン耐性黄色ブドウ球菌の特徴を明らかにする目的で，2009 年2 月から2012 年9 月に順天堂大学附属4 病院の皮膚科外来患者の検査材料から分離されたmethicillin-resistant Staphylococcus aureus（MRSA）54 株のStaphylococcal cassette chromosome mec（SCCmec）のタイプとMulti Locus Sequence Typing（MLST）を決定した．加えて4 種の毒素遺伝子の保有を検討した． 10 の染色体タイプ（Clonal Complex）と12 のSCCmec タイプが存在し，この二つの組み合わせで定義されるMRSA クローンは15 種類以上あった．最も多く検出されたのはClonal Complex（CC）5-typeIIa SCCmec 株（16 株）であった．我が国の院内感染事例から分離される株の多くが毒素性ショック症候群毒素遺伝子（toxic shock syndrome toxin gene ; tst）陽性のCC5-typeIIa SCCmec 株であるのに比べ，今回の供試菌株中ではtst 陽性のCC5-typeIIa SCCmec 株はわずか2 株で，他はtst 陰性であった．CC5 株以外が38 株（70.4％）あった．その中ではCC8 株が12 株と多かったが，tst 陽性CC8-typeIVl SCCmec 株9 株，Panton-Valentine Leukocidin（PVL）遺伝子（lukS，F-PV）を保有するCC8-typeIVa SCCmec 株1 株など，既知の毒素遺伝子保有株が10 株を占めた．続いて多かったのはとびひと関連するクローンでCC89-typeV SCCmec 株およびCC89-typeIIb SCCmec 株では，6 株中5 株および5 株中2 株がb 型表皮剥奪性毒素遺伝子（exofoliative toxin b ; etb）を保有していた．CC121-typeV SCCmec 株は，2 株中2 株がa 型表皮剥奪性毒素遺伝子（exofoliative toxin a ; eta）を保有していた．他にCC1-typeIVa SCCmec 株，CC8-typeI SCCmec 株，CC81-typeIVg SCCmec 株，CC97-typeIVc SCCmec 株，CC89-typeIVa SCCmec 株，CC91-typeIVa SCCmec 株，CC45-typeIIn SCCmec 株（サブタイプの決まらない株），CC59-typeIVg SCCmec 株，及び本研究で見いだされた新規サブタイプのCC8-typeIVm SCCmec, CC89-SCCmec 未同定株が存在し，多様なMRSA クローンが出現している状況が本検討で明らかにされた． |
| Author | 三澤, 成毅 吉池, 高志 小栗, 豊子 伊藤, 輝代 細谷, 志乃 平松, 啓一 |
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| References | 18 Nakao A, Ito T, Han X, Lu YJ, Hisata K, Atushi T, et al.：Intestinal carriage of methicillin resistant Staphylococcus aureus in nasal MRSA carriers hospitalized in the neonatal intensive care unit. Antimicrobial Resistance and Infection Control 2014；3：14. 5 Hisata K, Kuwahara-Arai K, Yamanoto M, Ito T,Nakatomi Y, Longzh C, et al.：Dissemination of Methicillin-Resistant Staphylococci among Healthy Japanese Children. J Clin Microbiol 2005；43：3364―72. 7 Higashiyama M, Ito T, Han X, Ono K, Mi namimura K, Sakakibara F, et al.：Epidural abscess caused by community-associated methicillin-resistant Staphylococcus aureus strain USA300 in Japan. J Infect Chemother 2010；16：345―9. 11 Enright MC, Day NP, Davies CE, Peacock SJ,Spratt BG：Multilocus sequence typing for characterization of methicillin-resistant and methicillin-susceptible clones of Staphylococcus aureus. J Clin Microbiol 2000；38：1008―15. 1 Salgado CD, Farr BM, Calfee DP：Communityacquired methicillin-resistant Staphylococcus aureus : a meta-analysis of prevalence and risk factors. Clin Infect Dis 2003；36：131―9. 14 Iwao Y, Ishii R, Tomita Y, Shibuya Y, Takano T, Hung WC, et al.：The emerging ST8 methicillin-resistant Staphylococcus aureus clone in the community in Japan : associated infections, genetic diversity, and comparative genomics. J Infect Chemother 2012；18：228― 40. 16 Mazmanian SK, Ton-That H, Schneewind O：Sortase-catalysed anchoring of surface proteins to the cell wall of Staphylococcus aureus.MolMicrobiol 2001；40：1049―57. 10 Kwon NH, Park KT, Moon JS, Jung WK, Kim SH, Kim JM, et al.：Staphylococcal cassette chromosome mec (SCCmec) characterization and molecular analysis for methicillin-resistant Staphylococcus aureus and novel SCCmec subtype IVg isolated from bovine milk in Korea. J Antimicrob Chemother 2005；56：624―32. 17 Roche FM, Massey R, Peacock SJ, Day NP, Vi sai L, Speziale P, et al.：Characterization of novel LPXTG-containing proteins of Staphylococcus aureus identified from genome sequences. Microbiology 2003；149：643―54. 8 Suzuki M, Tawada Y, Kato M, Hori H, Mamiya N, HayasHi Y, et al.：Development of a rapid strain differentiation method for methicillinresistant Staphylococcus aureus isolated in Japan by detecting phage-derived open-reading frames. J Appl Microbiol 2006；101：938―47. 13 Yamaguchi T, Nishifuji K, Sasaki M, Fudaba Y,Aepfelbacher M, Takata T, et al.：Identification of the Staphylococcus aureus etd pathogenicity island which encodes a novel exfoliative toxin,ETD, and EDIN-B. Infect Immun 2002；70：5835―45. 12 Ma XX, Ito T, Chongtrakool P, Hiramatsu K：Predominance of clones carrying Panton Valentine leukocidin genes among methicillinresistant Staphylococcus aureus strains isolated in Japanese hospitals from 1979 to 1985. J Clin Microbiol 2006；44：4515―27. 6 Shibuya Y, Hara M, Higuchi W, Takano T, Iwao Y, Yamamoto T, et al.：Emergence of the community-acquired methicillin-resistant Staphylococcus aureus USA300 clone in Japan. J Infect Chemother 2008；14：439―41. 15 Iwao Y, Takano T, Higuchi W, Yamamoto T：A new staphylococcal cassette chromosome mec IV encoding a novel cell-wall-anchored surface protein in a major ST8 community-acquired methicillin-resistant Staphylococcus aureus clone in Japan. J Infect Chemother 2012；18：96― 104. 4 Enright MC, Robinson D.A, Randle G, Feil E.J,Grundmann H., Spratt B.G：The evolutionary history of methicillin-resistant Staphylococcus aureus (MRSA). Proc Natl Acad Sci 2002；99：7687―92. 2 Klevens RM, Morrison MA, Nadle J, Petit S,Gershman K, Ray S, et al.：Invasive methicillin resistant Staphylococcus aureus infections in the United States. JAMA 2007；298：1763―71. 9 Kondo Y, Ito T, Ma XX, Watanabe S, Kreiswirth BN, Etienne J, et al.：Combination of multiplex PCRs for staphylococcal cassette chromosome mec type assignment : rapid identification system for mec, ccr, and major differences in junkyard regions. Antimicrob Agents Chemother 2007；51：264―74. 3 International Working Group on the Classification of Staphylococcal Cassette Chromosome Elements (IWG-SCC)：Classification of staphylococcal cassette chromosome mec (SCCmec):guidelines for reporting novel SCCmec elements. Antimicrob Agents Chemother 2009；53：4961―7. |
| References_xml | – reference: 15 Iwao Y, Takano T, Higuchi W, Yamamoto T：A new staphylococcal cassette chromosome mec IV encoding a novel cell-wall-anchored surface protein in a major ST8 community-acquired methicillin-resistant Staphylococcus aureus clone in Japan. J Infect Chemother 2012；18：96― 104. – reference: 2 Klevens RM, Morrison MA, Nadle J, Petit S,Gershman K, Ray S, et al.：Invasive methicillin resistant Staphylococcus aureus infections in the United States. JAMA 2007；298：1763―71. – reference: 4 Enright MC, Robinson D.A, Randle G, Feil E.J,Grundmann H., Spratt B.G：The evolutionary history of methicillin-resistant Staphylococcus aureus (MRSA). Proc Natl Acad Sci 2002；99：7687―92. – reference: 1 Salgado CD, Farr BM, Calfee DP：Communityacquired methicillin-resistant Staphylococcus aureus : a meta-analysis of prevalence and risk factors. Clin Infect Dis 2003；36：131―9. – reference: 3 International Working Group on the Classification of Staphylococcal Cassette Chromosome Elements (IWG-SCC)：Classification of staphylococcal cassette chromosome mec (SCCmec):guidelines for reporting novel SCCmec elements. Antimicrob Agents Chemother 2009；53：4961―7. – reference: 13 Yamaguchi T, Nishifuji K, Sasaki M, Fudaba Y,Aepfelbacher M, Takata T, et al.：Identification of the Staphylococcus aureus etd pathogenicity island which encodes a novel exfoliative toxin,ETD, and EDIN-B. Infect Immun 2002；70：5835―45. – reference: 18 Nakao A, Ito T, Han X, Lu YJ, Hisata K, Atushi T, et al.：Intestinal carriage of methicillin resistant Staphylococcus aureus in nasal MRSA carriers hospitalized in the neonatal intensive care unit. Antimicrobial Resistance and Infection Control 2014；3：14. – reference: 5 Hisata K, Kuwahara-Arai K, Yamanoto M, Ito T,Nakatomi Y, Longzh C, et al.：Dissemination of Methicillin-Resistant Staphylococci among Healthy Japanese Children. J Clin Microbiol 2005；43：3364―72. – reference: 7 Higashiyama M, Ito T, Han X, Ono K, Mi namimura K, Sakakibara F, et al.：Epidural abscess caused by community-associated methicillin-resistant Staphylococcus aureus strain USA300 in Japan. J Infect Chemother 2010；16：345―9. – reference: 9 Kondo Y, Ito T, Ma XX, Watanabe S, Kreiswirth BN, Etienne J, et al.：Combination of multiplex PCRs for staphylococcal cassette chromosome mec type assignment : rapid identification system for mec, ccr, and major differences in junkyard regions. Antimicrob Agents Chemother 2007；51：264―74. – reference: 10 Kwon NH, Park KT, Moon JS, Jung WK, Kim SH, Kim JM, et al.：Staphylococcal cassette chromosome mec (SCCmec) characterization and molecular analysis for methicillin-resistant Staphylococcus aureus and novel SCCmec subtype IVg isolated from bovine milk in Korea. J Antimicrob Chemother 2005；56：624―32. – reference: 16 Mazmanian SK, Ton-That H, Schneewind O：Sortase-catalysed anchoring of surface proteins to the cell wall of Staphylococcus aureus.MolMicrobiol 2001；40：1049―57. – reference: 12 Ma XX, Ito T, Chongtrakool P, Hiramatsu K：Predominance of clones carrying Panton Valentine leukocidin genes among methicillinresistant Staphylococcus aureus strains isolated in Japanese hospitals from 1979 to 1985. J Clin Microbiol 2006；44：4515―27. – reference: 17 Roche FM, Massey R, Peacock SJ, Day NP, Vi sai L, Speziale P, et al.：Characterization of novel LPXTG-containing proteins of Staphylococcus aureus identified from genome sequences. Microbiology 2003；149：643―54. – reference: 11 Enright MC, Day NP, Davies CE, Peacock SJ,Spratt BG：Multilocus sequence typing for characterization of methicillin-resistant and methicillin-susceptible clones of Staphylococcus aureus. J Clin Microbiol 2000；38：1008―15. – reference: 6 Shibuya Y, Hara M, Higuchi W, Takano T, Iwao Y, Yamamoto T, et al.：Emergence of the community-acquired methicillin-resistant Staphylococcus aureus USA300 clone in Japan. J Infect Chemother 2008；14：439―41. – reference: 8 Suzuki M, Tawada Y, Kato M, Hori H, Mamiya N, HayasHi Y, et al.：Development of a rapid strain differentiation method for methicillinresistant Staphylococcus aureus isolated in Japan by detecting phage-derived open-reading frames. J Appl Microbiol 2006；101：938―47. – reference: 14 Iwao Y, Ishii R, Tomita Y, Shibuya Y, Takano T, Hung WC, et al.：The emerging ST8 methicillin-resistant Staphylococcus aureus clone in the community in Japan : associated infections, genetic diversity, and comparative genomics. J Infect Chemother 2012；18：228― 40. |
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| Snippet | 我が国の市中に拡がるメチシリン耐性黄色ブドウ球菌の特徴を明らかにする目的で，2009 年2 月から2012 年9 月に順天堂大学附属4 病院の皮膚科外来患者の検査材料から分... |
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| Title | 皮膚科外来患者由来MRSA 株に見られる 新規MRSA クローンの出現状況 |
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