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JAC Advance Access originally published online on March 3, 2009
Journal of Antimicrobial Chemotherapy 2009 63(5):873-876; doi:10.1093/jac/dkp047
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© The Author 2009. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org
The online version of this article has been published under an open access model. Users are entitled to use, reproduce, disseminate, or display the open access version of this article for non-commercial purposes provided that: the original authorship is properly and fully attributed; the Journal and Oxford University Press are attributed as the original place of publication with the correct citation details given; if an article is subsequently reproduced or disseminated not in its entirety but only in part or as a derivative work this must be clearly indicated. For commercial re-use, please contact journals.permissions@oxfordjournals.org

Original research

Genotypic and phenotypic relationships among methicillin-resistant Staphylococcus aureus from three multicentre bacteraemia studies

Pamela A. Moise1,{dagger}, Davida S. Smyth2, D. Ashley Robinson2, Nadia El-Fawal2, Carlo McCalla2 and George Sakoulas2,3,*

1 University of the Pacific, Stockton, CA, USA 2 New York Medical College, Valhalla, NY, USA 3 Infectious Diseases, Sharp Memorial Hospital, San Diego, CA, USA

Received 19 October 2008; returned 23 December 2008; revised 7 January 2009; accepted 30 January 2009

* Corresponding author. Infectious Diseases, Sharp Memorial Hospital, 7910 Frost Street, Suite 320, San Diego, CA 92123, USA. Tel: +1-858-292-4211; Fax: +1-858-292-7117; E-mail: george.sakoulas{at}sharp.com

Background: At a time when the molecular epidemiology of methicillin-resistant Staphylococcus aureus (MRSA) was changing, we sought to characterize several genotypic markers and glycopeptide susceptibility features of clinical isolates from patients with bacteraemia.

Methods: One hundred and sixty-eight MRSA bloodstream isolates obtained from three multicentre clinical trials were microbiologically and genotypically characterized.

Results: All isolates were susceptible to vancomycin (MIC ≤ 2 mg/L); 38% belonged to accessory gene regulator (agr) group I, 52% belonged to group II and 10% belonged to group III. Typing of the staphylococcal cassette chromosome mec (SCCmec) showed that 67% were type II and 33% were type IV. The agr group II polymorphism was associated with SCCmec II (P < 0.001). Fifty-three percent of SCCmec II and 27% of SCCmec IV isolates had vancomycin MICs ≥1 mg/L (P = 0.001). One hundred percent of agr II strains were predicted to be members of clonal complex 5. SCCmec II was the genetic marker most predictive of vancomycin MICs of ≥1 mg/L. SCCmec IV isolates were more likely to have vancomycin MICs ≤0.5 mg/L.

Conclusions: Given that SCCmec IV is a marker for a community-based organism for which less prior vancomycin exposure is predicted, we conclude that prior antibiotic exposure in agr group II organisms may account for their increased vancomycin MICs.

Keywords: MRSA , SCCmec types , clonal types , Staphylococcus spp.

{dagger} Present address: Cubist Pharmaceuticals, 65 Hayden Avenue, Lexington, MA 02421, USA.


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