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In vivo evolution of antimicrobial resistance in a series of Staphylococcus aureus patient isolates: the entire picture or a cautionary tale?

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Author(s)

Sebastiaan J van Hal, Jason A Steen, Björn A Espedido, Sean M Grimmond, Matthew A Cooper, Matthew T G Holden, Stephen D Bentley, Iain B Gosbell, Slade O Jensen

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Abstract

Objectives To obtain an expanded understanding of antibiotic resistance evolution in vivo, particularly in the context of vancomycin exposure.

Methods The whole genomes of six consecutive methicillin-resistant Staphylococcus aureus blood culture isolates (ST239-MRSA-III) from a single patient exposed to various antimicrobials (over a 77 day period) were sequenced and analysed.

Results Variant analysis revealed the existence of non-susceptible sub-populations derived from a common susceptible ancestor, with the predominant circulating clone(s) selected for by type and duration of antimicrobial exposure.

Conclusions This study highlights the dynamic nature of bacterial evolution and that non-susceptible sub-populations can emerge from clouds of variation upon antimicrobial exposure. Diagnostically, this has direct implications for sample selection when using whole-genome sequencing as a tool to guide clinical therapy. In the context of bacteraemia, deep sequencing of bacterial DNA directly from patient blood samples would avoid culture ‘bias’ and identify mutations associated with circulating non-susceptible sub-populations, some of which may confer cross-resistance to alternate therapies.
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Details

Original languageEnglish
Pages (from-to)363-7
Number of pages5
JournalJournal of Antimicrobial Chemotherapy
Volume69
Issue number2
Early online date18 Sep 2013
DOIs
Publication statusPublished - Feb 2014

    Research areas

  • MRSA, Sub-populations, Genomics, Diagnostics

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