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2017 ; 18
(1
): 130
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Methicillin-resistant Staphylococcus aureus emerged long before the introduction
of methicillin into clinical practice
#MMPMID28724393
Harkins CP
; Pichon B
; Doumith M
; Parkhill J
; Westh H
; Tomasz A
; de Lencastre H
; Bentley SD
; Kearns AM
; Holden MTG
Genome Biol
2017[Jul]; 18
(1
): 130
PMID28724393
show ga
BACKGROUND: The spread of drug-resistant bacterial pathogens poses a major threat
to global health. It is widely recognised that the widespread use of antibiotics
has generated selective pressures that have driven the emergence of resistant
strains. Methicillin-resistant Staphylococcus aureus (MRSA) was first observed in
1960, less than one year after the introduction of this second generation
beta-lactam antibiotic into clinical practice. Epidemiological evidence has
always suggested that resistance arose around this period, when the mecA gene
encoding methicillin resistance carried on an SCCmec element, was horizontally
transferred to an intrinsically sensitive strain of S. aureus. RESULTS: Whole
genome sequencing a collection of the first MRSA isolates allows us to
reconstruct the evolutionary history of the archetypal MRSA. We apply Bayesian
phylogenetic reconstruction to infer the time point at which this early MRSA
lineage arose and when SCCmec was acquired. MRSA emerged in the mid-1940s,
following the acquisition of an ancestral type I SCCmec element, some 14 years
before the first therapeutic use of methicillin. CONCLUSIONS: Methicillin use was
not the original driving factor in the evolution of MRSA as previously thought.
Rather it was the widespread use of first generation beta-lactams such as
penicillin in the years prior to the introduction of methicillin, which selected
for S. aureus strains carrying the mecA determinant. Crucially this highlights
how new drugs, introduced to circumvent known resistance mechanisms, can be
rendered ineffective by unrecognised adaptations in the bacterial population due
to the historic selective landscape created by the widespread use of other
antibiotics.