title: Tracking the in vivo evolution of multidrug resistance in Staphylococcus aureus by whole-genome sequencing.
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.
authors.affiliation: Physics Department, Cornell University, Ithaca, NY 14850, USA.
authors.forename: Michael M
authors.initials: MM
authors.lastname: Mwangi
authors.forename: Shang Wei
authors.initials: SW
authors.lastname: Wu
authors.forename: Yanjiao
authors.initials: Y
authors.lastname: Zhou
authors.forename: Krzysztof
authors.initials: K
authors.lastname: Sieradzki
authors.forename: Herminia
authors.initials: H
authors.lastname: de Lencastre
authors.forename: Paul
authors.initials: P
authors.lastname: Richardson
authors.forename: David
authors.initials: D
authors.lastname: Bruce
authors.forename: Edward
authors.initials: E
authors.lastname: Rubin
authors.forename: Eugene
authors.initials: E
authors.lastname: Myers
authors.forename: Eric D
authors.initials: ED
authors.lastname: Siggia
authors.forename: Alexander
authors.initials: A
authors.lastname: Tomasz
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology; D001483:Base Sequence; D005075:Biological Evolution; D018432:Drug Resistance, Multiple / Q000187:drug effects / Q000235:genetics*; D020869:Gene Expression Profiling; D015964:Gene Expression Regulation, Bacterial; D016680:Genome, Bacterial / Q000235:genetics*; D006801:Humans; D009154:Mutation / Q000235:genetics; D010641:Phenotype; D012293:Rifampin / Q000494:pharmacology; D013203:Staphylococcal Infections / Q000473:pathology / Q000635:transmission; D013211:Staphylococcus aureus / Q000187:drug effects / Q000235:genetics* / Q000302:isolation & purification; D014640:Vancomycin / Q000494:pharmacology; D018440:beta-Lactam Resistance / Q000187:drug effects
chemical_list: D000900:Anti-Bacterial Agents; D014640:Vancomycin; D012293:Rifampin