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Cited by 538

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Tracking the in vivo evolution of multidrug resistance in Staphylococcus aureus by whole-genome sequencing

Open access
Mwangi, Michael M., Wu, Shang Wei, Zhou, Yanjiao, Sieradzki, Krzysztof, de Lencastre, Herminia, Richardson, Paul, Bruce, David, Rubin, Edward, Myers, Eugene, Siggia, Eric D., Tomasz, Alexander·2007·Proceedings of the National Academy of Sciences
DOI 10.1073/pnas.0609839104
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Abstract

The spread of multidrug-resistant Staphylococcus aureus (MRSA) strains in the clinical environment has begun to pose serious limits to treatment options. Yet virtually nothing is known about how resistance traits are acquired in vivo . Here, we apply the power of whole-genome sequencing to identify steps in the evolution of multidrug resistance in isogenic S. aureus isolates recovered periodically from the bloodstream of a patient undergoing chemotherapy with vancomycin and other antibiotics. After extensive therapy, the bacterium developed resistance, and treatment failed. Sequencing the first vancomycin susceptible isolate and the last vancomycin nonsusceptible isolate identified genome wide only 35 point mutations in 31 loci. These mutations appeared in a sequential order in isolates that were recovered at intermittent times during chemotherapy in parallel with increasing levels of resistance. The vancomycin nonsusceptible isolates also showed a 100-fold decrease in susceptibility to daptomycin, although this antibiotic was not used in the therapy. One of the mutated loci associated with decreasing vancomycin susceptibility (the vraR operon) was found to also carry mutations in six additional vancomycin nonsusceptible S. aureus isolates belonging to different genetic backgrounds and recovered from different geographic sites. As costs drop, whole-genome sequencing will become a useful tool in elucidating complex pathways of in vivo evolution in bacterial pathogens.

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Authors
Mwangi, M. M., Wu, S. W., Zhou, Y., Sieradzki, K., de Lencastre, H., Richardson, P., Bruce, D., Rubin, E., Myers, E., Siggia, E. D., & Tomasz, A.
Venue
Proceedings of the National Academy of Sciences
Publisher
Proceedings of the National Academy of Sciences
Published
2007-05-29
Volume
104
Issue
22
Pages
9451-9456
ISSN
  • 0027-8424 (ISSN-L)
  • 1091-6490
DOI
10.1073/pnas.0609839104
OpenAlex
W2146370523
Cited by
538
References
0
FWCI
23.11
Type
journal article
Language
en
Open access
green

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