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Updated: May 5, 2026
Subcutaneous Infection of Methicillin Resistant Staphylococcus Aureus MRSA
Published on: February 9, 2011
Genomic characterization of healthcare-associated ST5 MRSA causing severe pseudomembranous enteritis in intensive
Lu Sun1,2, Feiteng Zhu1,2, Yiyi Chen1,2
1Department of Infectious Diseases, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.
Background:
Methicillin resistant Staphylococcus aureus (MRSA) is one of the main causes of hospital-acquired infections, but the diagnosis of MRSA pseudomembranous enteritis has faded in recent years. Here, we reported a pseudomembranous enteritis case in a young male patient caused by ST5 MRSA.
Methods:
Clinical data of the patient were collected from medical records. Mass spectrometry identification, antimicrobial susceptibility testing, whole genome sequencing, as well as resistance and virulence genes detection of MRSA strain were performed.
Results:
A 27-year-old young man with acute pancreatitis and septic shock in the intensive care unit passed large volume of intestine-like "stool" with more than 200 centimetres in length. A large number of Gram-positive cocci was persistently found in the stool samples. Histopathological examination of the intestine-like stool revealed that this stool was actually pseudomembrane, consisting of fibrinous exudate, inflammatory cells and clusters of gram-positive cocci adjacent to the luminal border. The patient was suspected for diagnosis of pseudomembranous enteritis. Stool and gastric juice cultures were positive for MRSA. These strains belonged to ST5-SCCmec II-t311, and harbored abundant virulence genes, especially enterotoxin genes. They contained not only sea, sec3, sel, but an enterotoxin gene cluster (egc, seg, sei, sem, sen, seo, yent1 and yent2), which may serve as an enterotoxin gene nursery. Besides, the strains were related to the isolates of the same hospital between 2013 and 2015, and there may be nosocomial transmission.
Conclusions:
The severe clinical symptoms in this patient and the described virulence genes all suggested that these ST5 strains belonged to a kind of hypervirulent MRSA lineage. At the same time, the analysis of cgMLST indicated that there might be nosocomial transmission, which required the society to pay more attention to this highly virulent nosocomial clone.
Insights
A young man developed severe pseudomembranous enteritis caused by ST5 Methicillin-resistant Staphylococcus aureus (MRSA). This hypervirulent MRSA strain possessed numerous virulence genes and may indicate nosocomial transmission, highlighting the need for increased vigilance.
Area of Science:
- Infectious Diseases
- Microbiology
- Genomics
Background:
- Methicillin-resistant Staphylococcus aureus (MRSA) is a significant cause of hospital-acquired infections.
- Diagnosis of MRSA pseudomembranous enteritis has become less common.
- This study reports a case of pseudomembranous enteritis caused by ST5 MRSA in a young male patient.
Purpose of the Study:
- To report a rare case of pseudomembranous enteritis caused by ST5 MRSA.
- To characterize the virulence factors and genetic relatedness of the causative MRSA strain.
- To investigate potential nosocomial transmission of this MRSA clone.
Main Methods:
- Collected clinical data from patient medical records.
- Performed mass spectrometry identification and antimicrobial susceptibility testing.
- Conducted whole genome sequencing to detect resistance and virulence genes.
Main Results:
- A 27-year-old male patient in the ICU presented with severe pseudomembranous enteritis.
- MRSA strains identified from stool and gastric juice belonged to ST5-SCCmec II-t311.
- The MRSA strains harbored extensive virulence genes, including an enterotoxin gene cluster, and showed relatedness to hospital isolates from 2013-2015.
Conclusions:
- The ST5 MRSA strain exhibited hypervirulence due to its extensive virulence genes.
- cgMLST analysis suggested potential nosocomial transmission of this highly virulent clone.
- Increased attention is needed for this hypervirulent nosocomial MRSA clone.
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