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Abstract：
Previous studies have mainly focused on outpatient cases of skin and soft tissue infections (SSTIs), with limited attention to inpatient occurrences. Thus, we aimed to compare the clinical parameters of inpatients with SSTIs, performed genomic characterization, and determined the subtypes of Panton-Valentine leucocidin (PVL) bacteriophages of methicillin-resistant Staphylococcus aureus (MRSA) strains isolated from these patients. We found that PVL-positive patients had shorter hospital stays (mean, 9 vs. 24 days; p < 0.001) and abscess resolution durations (mean, 8 vs. 13 days; p < 0.01). PVL-positive MRSA-induced SSTIs were more frequently associated with abscesses [36/55 (65.5%) vs. 15/124 (12.1%), p < 0.001], with 52.7% undergoing incision and drainage; over 80% of PVL-negative patients received incision, drainage, and antibiotics. In PVL-positive patients receiving empirical antibiotics, anti-staphylococcal agents such as vancomycin and linezolid were administered less frequently (32.7%, 18/55) than in PVL-negative patients (74.2%, 92/124), indicating that patients with PVL-positive SSTIs are more likely to require surgical drainage rather than antimicrobial treatment. We also found that the ST59 lineage was predominant, regardless of PVL status (41.3%, 74/179). Additionally, we investigated the linear structure of the lukSF-PV gene, revealing that major clusters were associated with specific STs, suggesting independent acquisition of PVL by different strain types and indicating that significant diversity was observed even within PVL-positive strains detected in the same facility. Overall, our study provides comprehensive insights into the clinical, genetic, and phage-related aspects of MRSA-induced SSTIs in hospitalized patients and contributes to a more profound understanding of the epidemiology and evolution of these pathogens in the Chinese population.
摘要：
以前的研究主要集中在皮肤和软组织感染（STTI）的门诊病例，对住院事件的关注有限。因此，我们的目的是比较住院患者的临床参数，进行基因组表征，并确定了从这些患者中分离出的耐甲氧西林金黄色葡萄球菌（MRSA）菌株的Panton-Valentineleucocidin（PVL）噬菌体的亚型。我们发现PVL阳性患者的住院时间较短(平均，9vs.24天；p<0.001）和脓肿消退持续时间（平均值，8vs.13天；p<0.01)。PVL阳性MRSA诱导的SSTI更频繁地与脓肿相关[36/55（65.5％）15/124（12.1%），p<0.001],52.7%接受切开引流术；超过80%的PVL阴性患者接受切开引流术，排水,和抗生素。在接受经验性抗生素的PVL阳性患者中，抗葡萄球菌药物如万古霉素和利奈唑胺的使用频率较低(32.7%，18/55）比PVL阴性患者（74.2%，92/124)，表明PVL阳性SSTI患者更可能需要手术引流而不是抗菌治疗。我们还发现ST59谱系占主导地位，无论PVL状态如何(41.34%，74/179)。此外,我们研究了lukSF-PV基因的线性结构，揭示主要集群与特定的STs相关，表明不同菌株类型对PVL的独立获取，并表明即使在同一设施中检测到的PVL阳性菌株中也观察到显着的多样性。总的来说,我们的研究提供了对临床的全面见解，遗传,以及住院患者中MRSA诱导的SSTI的噬菌体相关方面，有助于对中国人群中这些病原体的流行病学和进化有更深刻的了解。
