Genotypic and phenotypic diversity of Staphylococcus aureus from cystic fibrosis lung infections and their interactions with Pseudomonas aeruginosa

Pseudomonas aeruginosa and Staphylococcus aureus are the most common bacteria that infect the respiratory tract of individuals with the genetic disease cystic fibrosis (CF); in fact, S. aureus has recently overtaken P. aeruginosa to become the most common. Substantial research has been performed on the epidemiology of S. aureus in CF; however, there appears to be a gap in knowledge in regard to the pathogenesis of S. aureus in the context of CF lung infections. Most studies have focused on a few S. aureus isolates, often exclusively laboratory adapted strains, and how they are killed by P. aeruginosa. Because of this, little is known about the diversity of S. aureus CF lung isolates in both virulence and interaction with P. aeruginosa. To begin to address this gap in knowledge, we recently sequenced 65 clinical S. aureus isolates from the Emory CF Biospecimen Registry and Boston Childrens Hospital, including the reference isolate JE2, a USA300 strain. Here, we analyzed antibiotic resistance genotypes, sequence type, clonal complex, spa type, and agr type of these isolates. We hypothesized that major virulence phenotypes of S. aureus that may be associated with CF lung infections, namely toxin production and mucoid phenotype, would be retained in these isolates. To test our hypothesis, we plated on specific agars and found that most isolates can hemolyze both rabbit and sheep blood (67.7%) and produce polysaccharide (69.2%), consistent with virulence retention in CF lung isolates. We also identified three distinct phenotypic groups of S. aureus based on their survival in the presence of nonmucoid P. aeruginosa laboratory strain PAO1 and its mucoid derivative. Altogether, our work provides greater insight into the diversity of S. aureus CF isolates, specifically the distribution of important virulence factors and their interaction with P. aeruginosa, all of which have implications in patient health.\n\nAuthor SummaryStaphylococcus aureus is now the most frequently detected pathogen in the lungs of individuals who have cystic fibrosis (CF), followed closely by Pseudomonas aeruginosa. When these two pathogens are found to coinfect the CF lung, patients have a significantly worse prognosis. While P. aeruginosa has been rigorously studied in the context of bacterial pathogenesis in CF, less is known about S. aureus. Here we present an in-depth study of 64 S. aureus CF clinical isolates where we investigated genetic diversity utilizing whole genome sequencing, virulence phenotypes, and interactions with P. aeruginosa. We have found that S. aureus isolated from the CF lung are phylogenetically diverse, most retain known virulence factors, and they vary in interactions with P. aeruginosa from highly sensitive to completely tolerant. Deepening our understanding of how S. aureus responds to its environment and other microbes in the CF lung will enable future development of effective treatments and preventative measures against these formidable infections.