The remarkable genetic relationship between Staphylococcus aureus isolates from hemodialysis patients and their household contacts: Homes as an important source of colonization and dissemination

PLOS ONE RESEARCH ARTICLE The remarkable genetic relationship between Staphylococcus aureus isolates from hemodialysis patients and their household contacts: Homes as an important source of colonization and dissemination Daniela Montoya Urrego ID1, Johanna M. Vanegas1,2, J. Natalia Jiménez ID1* a1111111111 a1111111111 a1111111111 a1111111111 a1111111111 1 Grupo de investigación en Microbiologı́a Básica y aplicada (MICROBA), Escuela de Microbiologı́a, Universidad de Antioquia, Medellı́n, Colombia, 2 Grupo de investigación en Salud Pública, Escuela de Ciencias de la Salud, Universidad Pontificia Bolivariana, Medellı́n, Colombia * Abstract OPEN ACCESS Citation: Montoya Urrego D, Vanegas JM, Jiménez JN (2022) The remarkable genetic relationship between Staphylococcus aureus isolates from hemodialysis patients and their household contacts: Homes as an important source of colonization and dissemination. PLoS ONE 17(4): e0267276. https://doi.org/10.1371/journal. pone.0267276 Editor: Herminia de Lencastre, The Rockefeller University, UNITED STATES Received: January 6, 2022 Introduction Staphylococcus aureus is a successful pathogen in hospital and community. Hemodialysis patients have high colonization rates. Interactions between them and their household contacts, are an opportunity to understand the S. aureus colonization between hospitals and community. This study aims to determine the clinical and epidemiological characteristics of S. aureus colonization in hemodialysis patients and their household contacts, as well as the genetic relationship between their isolates. Methods Accepted: April 5, 2022 Published: April 19, 2022 Copyright: © 2022 Montoya Urrego et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Data Availability Statement: All relevant data are within the manuscript and its Supporting Information files. Funding: This work was supported by Departamento Administrativo de Ciencia, Tecnologı́a e innovación (MinCiencias Project: 111577756947), and Comite para el Desarrollo de la Investigacion CODI, Universidad de Antioquia, project: 2017-15526. The funders had no role in A cross-sectional study was conducted on hemodialysis patients from hospital-associated dialysis center in Medellı́n-Colombia, and their household contacts between 2019 and 2020. Colonization was assessed in the nostrils for household contacts and nostrils and skin around the catheter insertion for hemodialysis patients. Epidemiological information was obtained, and colonization was evaluated in their pets’ oral cavities. Bacterial identification and susceptibility were assessed using phenotypic and molecular methods. Molecular typing included SCCmec typing, pulsed-field gel electrophoresis (PFGE), spa typing, and virulence factor detection. Results Colonization frequency was 35.6% (n = 16/45) in patients (87.5% MSSA– 12.5% MRSA) and 43.1% (n = 53/123) in household contacts (88.7% MSSA—11.3% MRSA). Of 45 homes, 77.8% presented colonized people. Colonization was detected in at least two household members in 46.7% of homes, of which 52.4% had a genetic relationship. PLOS ONE | https://doi.org/10.1371/journal.pone.0267276 April 19, 2022 1 / 12 PLOS ONE study design, data collection and analysis, decision to publish, or preparation of the manuscript. Competing interests: The authors have declared that no competing interests exist. Homes as an important source of colonization by S. aureus in hemodialysis patients and community Colonization was 16% (n = 4/25) in pets (75% MRSA—25% MSSA). The most frequent clonal complex was CC8 (15.6%), and the spa typing revealed high diversity. Conclusion This study shows a high frequency of colonization by S. aureus in both hemodialysis patients and their household contacts and a significant genetic relationship between their isolates. This demonstrates an exchange of this bacterium and that homes are an important source of colonization to patients, highlighting the need for prevention strategies outside the hospital to avoid future infections, and the importance of the populations with permanent transit between the two environments. Introduction Colonization by Staphylococcus aureus is considered an important risk factor for the development of skin and soft tissue infections and invasive infections in different groups of patients. Hemodialysis patients present comorbidities and specific clinical characteristics that favor high frequencies of colonization, even greater than those reported in hospitalized patients [1, 2]. Colonization by S. aureus in hemodialysis patients has serious implications due to its relationship with the development of endogenous infections, especially when colonization occurs persistently, as reported in a previous study that found that 77.8% of hemodialysis patients who developed S. aureus bacteremia were previously colonized by this microorganism [3]. Additionally, colonization in these patients increases the risk of the spread of the microorganisms both in health institutions and community because they can act as asymptomatic reservoirs and transporters of these bacteria for long periods, facilitating their transmission to people with whom they closely interact, such as their relatives and contacts within the community [4, 5]. In this way, hemodialysis patients and their household contacts are a model population to understand the dynamics of the dissemination of MSSA and MSRA between the hospital and the community because they constantly circulate between the two environments [4]. Also, the household contacts have a direct link of care and accompaniment with patients, which is why they share spaces, objects, and habits that can facilitate the transmission of bacteria among them [2]. At the same time, social, economic, epidemiological, cultural, and environmental factors converge in this population, which can favor the colonization by resistant bacteria from other environments than the hospital. Taking into account that in Colombia, and particularly in Medellı́n, colonization by S. aureus in hemodialysis patients has been reported at 50.9% [6], in this study, it was proposed to determine the clinical and epidemiological characteristics of S. aureus colonization in hemodialysis patients and their household contacts, as well as the genetic relationship between their isolates, to establish and identify opportunities to prevent colonization and future infections in patients from non-hospital environments. Materials and methods Study population A cross-sectional study was conducted between June 2019 and May 2020 with hemodialysis patients and their household contacts. The hemodialysis patients belong to a hospital- PLOS ONE | https://doi.org/10.1371/journal.pone.0267276 April 19, 2022 2 / 12 PLOS ONE Homes as an important sourc (...truncated)