Molecular typing of clinical Staphylococcus aureus isolates from northern India using coagulase gene PCR-RFLP

Molecular typing of total 84 Staphylococcus aureus clinical isolates was performed using coagulase gene PCR. Out of 84 S. aureus strains total 33 different types of S. aureus strains were prevalent in this hospital and community. Types 2-7 and 9 were the most prevalent S. aureus strains accounting for more than 53% of total isolates. This technique is relatively inexpensive and is simple to perform and analyze.

Strain-relatedness of methicillin-resistant Staphylococcus aureus isolates recovered from patients with repeated infection

Invasive disease following methicillin-resistant Staphylococcus aureus (MRSA) detection is common, regardless of whether initial detection involves colonization or infection. We assessed the genetic relatedness of isolates obtained > or =2 weeks apart representing either repeated infections or colonization-infection sets to determine if infections are likely to be caused by previously harbored strains. We found that MRSA infection following initial colonization or infection is caused by the same strain in most cases, suggesting that a single successful attempt at decolonization may prevent the majority of later infection.

Methicillin resistance in Staphylococcus aureus and coagulase-negative staphylococci: epidemiological and molecular aspects

Infections caused by the genus Staphylococcus are of great importance for human health. Staphylococcus species are divided into coagulase-positive staphylococci, represented by S. aureus, a pathogen that can cause infections of the skin and other organs in immunocompetent patients, and coagulase-negative staphylococci (CNS) which comprise different species normally involved in infectious processes in immunocompromised patients or patients using catheters. Oxacillin has been one of the main drugs used for the treatment of staphylococcal infections; however, a large number of S. aureus and CNS isolates of nosocomial origin are resistant to this drug. Methicillin resistance is encoded by the mecA gene which is inserted in the SCC mec cassette. This cassette is a mobile genetic element consisting of five different types and several subtypes. Oxacillin-resistant strains are detected by phenotypic and genotypic methods. Epidemiologically, methicillin-resistant S. aureus strains can be divided into five large pandemic clones, called Brazilian, Hungarian, Iberian, New York/Japan and Pediatric. The objective of the present review was to discuss aspects of resistance, epidemiology, genetics and detection of oxacillin resistance in Staphylococcus spp., since these microorganisms are increasingly more frequent in Brazil.

Development and validation of microarray-based assay for epidemiological study of MRSA

We have developed a microarray-based assay for the genotyping of Staphylococcus aureus strains. A DNA microarray consisting of 221 genes with 390 oligonucleotide probes was designed to identify characteristic genes or gene alleles of S. aureus. The 221 genes were chosen on the basis of the following criteria: (i) genes used as control for the microarray system, (ii) virulence genes, (iii) resistance genes and their regulators, and (iv) genes constituting genomic islands, e.g., SCCmec. The microarray system was established by determining the method to prepare targets by random-primer labeling with chromosomal DNA and the conditions for hybridization. We verified the system by using DNAs of seven strains, the genome of which has been fully sequenced. Furthermore, the presence of 32 genes and the types of SCCmec elements and coagulase genes carried by another 27 strains were examined and compared with the results of PCR. As a result, the presence or absence of 182 genes out of the 221 genes was verified. Our data showed the usefulness of the oligonucleotide microarray based assay in identifying important marker sets, such as toxin genes, resistance genes, SCCmec elements, and coagulase genes, for the molecular epidemiology of S. aureus.

[Evaluation of IDI-MRDA assay on a collection of community-acquired methicillin-resistant Staphylococcus aureus isolates and on carriage specimens]

The efficacy of infection control measures against MRSA is linked to the rapid detection of MRSA. With the conventional diagnosis by culture the response delays vary from 48 to 72 hours. In contrast molecular techniques give results within hours.

OBJECTIVE

The objective of the present study is to perform the IDI-MRSA PCR test (BD Diagnostic GeneOhm) on a collection of characterized community-acquired MRSA (CA-MRSA) isolates and on carriage specimens. COLLECTION OF ISOLATES: Fifty-two isolates of CA-MRSA previously characterised by their toxinotype and SCCmec type cassette were analysed. All of them were identified as MRSA by the IDI-MRSA test.

SPECIMENS

Seventy screening specimens from 35 different patients were tested in comparison with the culture on specific media (MRSA ID, BioMérieux). Among those 70 specimens, 24 were from nose, 25 from cutaneous sites (axillar; groin) and 21 from other sites. Sensitivity and specificity were 86.4 and 91.3% respectively; positive and negative predictive values were 93.3 and 82.6% respectively.

RESULTS

Three of four false-positive results came from specimens collected during a decolonisation treatment. Without taking account those specimens, specificity and positive predictive reach 97.9 and 95% respectively. This study shows that IDI-MRSA is an interesting additional test for the diagnosis of MRSA carriage.

[Clonal transmission of methicillin-resistant S. aureus (MRSA) strain in two surgical wards in Lódź]

OBJECTIVE

Phenotypic and genotypic characteristics of S. aureus strains isolated from selected operative wards.

METHODS

A group of 50 strains were analysed. Bacterial strains were isolated from three operative wards of Pirogow Specialistic Hospital in Lódź in a year. Biochemical properties and drug resistance were estimated using standard microbiological techniques. PCR MP technique was used for genotypic analysis.

MAIN OBSERVATIONS

A convergence of genotyping results and antibiotic resistance profiles among MRSA strains was observed. Thus, the antibiogram may serve as the instrument for the preliminary typing of S. aureus strains that may be related. However, this hypothesis has to be verified, for example by using PCR MP technique.

RESULTS

Methicillin-resistance was demonstrated in 24 out of 50 S. aureus isolates. Most MRSA strains (19 out of 24) presented multidrugresistance. Twelve various profiles of enzymatic activity and fifteen different genotypes (A-O) were singled out among the investigated strains. Profile A, recorded in 20 strains, was most frequent (Dice Coefficient: 0.80-0.94).

CONCLUSIONS

1. S. aureus strains present high resistance to antibiotics frequently showing multidrug-resistance coupled with methicillin-resistance 2. Genetically related MRSA strains present a stable drug-resistance pattern 3. Clonal transmission of MRSA strain was observed in two operative wards 4. The disc-diffusion method for testing antibiotic-resistance and PCR MP technique are useful in epidemiological investigation for S. aureus.

[Investigation of the virulence genes in methicillin-resistant Staphylococcus aureus strains isolated from biomaterial surfaces]

Staphylococci are the most important agents of nosocomial infections originating from biomaterials. The aim of this study was to investigate the presence of virulence genes and their phenotypic expressions in 11 methicillin-resistant Staphylococcus aureus strains isolated from the surfaces of clinically used biomaterials of 48 thorasic intensive-care unit patients. By the use of specific primers, the presence of genes encoding the attachment and biofilm production (icaA, icaC, bap), methicillin resistance (mecA), enterotoxins A-E (sea, seb, sec, sed, see), toxic shock syndrome toxin (tst), exfoliative toxins A and B (eta and etb), alpha- and beta-hemolysins (hla and hlb), staphylococcal exotoxin-like protein-1 (set1), proteases (sspA, sspB, aur, serine proteaz gene), lipase (geh) and the regulatory genes (sarA and agrCA) were investigated by polymerase chain reaction (PCR). The phenotypic properties of the isolates such as biofilm formation, antibiotic susceptibility, extracellular protease and lipase production were also evaluated. None of the isolates were found to be biofilm and/or slime producers, however, all strains were found to have icaA gene which is responsible for biofilm formation. Nevertheless the presence of icaC and bap genes that are also responsible for biofilm formation were not detected. All the strains have had mecA gene and were resistant to oxacillin, penicilin G and gentamicin, while 10 were also resistant to erythromycin and nine were also resistant to ofloxacin. The isolates were susceptible to vancomycin, teicoplanin and co-trimoxazole. Screening of toxin and regulatory genes revealed that all the strains harboured sea, set1, hla, hlb and sarA genes. The phenotypic tests for the determination of extracellular protease production revealed that all the strains formed very weak zones on skim milk and milk agar plates, and yielded negative results on casein agar plates. Furthermore, all strains were found to harbour sspA, sspB, aur and serine protease genes. Tween 20, Tween 80 and tributyrin containing media were used to detect lipase production and all strains gave late-positive results (on the third day of incubation), although they all lacked for lipase gene (geh). As a result, S. aureus strains isolated from biomaterial surfaces yielded positivity for some of the tested virulence genes, of which some of them have not been expressed phenotypically. Although there were some limitations in the study, it could be concluded that the presence of these virulence genes in S. aureus strains might be considered as potential threats especially in intensive care unit patients.

[Susceptibility of Staphylococcus aureus to new macrolide antibiotics]

A total of 73 isolates of Staphylococcus aureus (26 - MRSA, 47 - MSSA) were tested for their susceptibility to macrolide antibiotics and new derivatives (azalide - azythromycin and ketolide -telithromycin). We observed a high - level resistance of MRSA isolates to all tested antibiotics. Over 96% of isolates were resistant to macrolides and azalides and 92,3% to ketolides. Majority of MSSA isolates (93.6%) demonstrated a high-level susceptibility to telithromycin. Mechanisms of resistance to macrolide antibiotics (34 - MLSB and 1 - MSB) were found among 47,9% Staphylococcus aureus isolates. All of MSSA (100%) and 40% MRSA isolates with induction phenotype of resistance (MLSB(I)) were sensitive to telithromycin. Isolates with constitutive phenotype of resistance (MLSB(K)) were resistant to all of the tested antibiotics.

Accessory gene regulator (agr) typing of Staphylococcus aureus isolated from human infections

Staphylococcus aureus is a major hospital and community acquired pathogen. A total of one hundred strains were investigated. They were collected from January 2004 to July 2006 in the laboratory of microbiology at Charles Nicolle University hospital of Tunis. The isolates were identified by conventional methods. Methicillin resistance was confirmed by amplification of mecA gene by PCR. The agr groups were identified by multiplex PCR. The agr groups were distributed as follows: 19 strains belonged to group I, 16 to group II and 65 to group III. Among methicillin resistant S. aureus (MRSA), 9 (16.4%) belonged to group 1, 8 (14.5%) to group II and 38 (69.1%) to group IlI. For methicillin susceptible S. aureus (MSSA), only 10 strains (22.2%) belonged to group I, 8 (17.8%) to group II and 27 (60%) to group III. A preferential link was observed between agr group I and invasive infections (P=0.003) especially bacteremia (P=10(-4). Besides, agr groups II and III were closely related with non invasive infections (P=0.003). No association was found between other types of infections and agr groups. Likewise, no correlation was observed between agr groups, age or sex of patients and type of infections.

Laboratory detection methods for methicillin resistance in coagulase negative Staphylococcus isolated from ophthalmic infections

PURPOSE

To evaluate different methods of oxacillin susceptibility testing of ocular isolates, considering polymerase chain reaction (PCR) as the 'gold standard', and to compare the in vitro susceptibility to oxacillin with that of other antimicrobials used in ophthalmologic practice.

METHODS

The Vitek gram-positive identification card was used to identify ocular coagulase negative Staphylococcus species. The presence of the mecA gene was determined by the polymerase chain reaction assay with a combination of two primer sets (mecA and 16S rRNA) in a single region. Results were analyzed and compared with other oxacillin susceptibility methods: PBP2a detection by rapid slide latex agglutination test (SLA); oxacillin E-test; the Vitek automated gram-positive susceptibility card (GPS-105); the oxacillin salt agar screening test (OSAS) at a concentration of 6.0, 1.0 and 0.75 microg oxacillin per ml and the cefoxitin disk diffusion test (CDD). Automated susceptibility was also determined to other antimicrobial agents (fluoroquinolones, penicillin G, amoxicillin-ampicillin, cefazolin, ampicillin-sulbactam, erythromycin, clindamycin, gentamicin, tetracycline, trimethoprim-sulfamethoxazole, vancomycin and rifampin.

RESULTS

Of the 69 CoNS isolates tested, 71% were mecA-positive and 29% mecA-negative. All methods tested had a statistically significant agreement with polymerase chain reaction. There was a tendency of positive polymerase chain reaction predomination among the S. epidermidis isolates in comparison to non-epidermidis isolates, although this was not statistically significant (78.3% vs. 56.5%; chi2= 2.54; P= 0.11). The oxacillin salt agar screening test (0.75 microg oxacillin/ml) showed the best performance, with 100% sensitivity and negative predictive value; 95% specificity and 98% positive predictive value. Using the E-test, the mecA-positive isolates were statistically significantly more resistant to ciprofloxacin, ofloxacin, gatifloxacin and moxifloxacin (P= 0.002; P= 0.008; P= 0.002 and P= 0.003, respectively). There was a statistically significant higher proportion of resistance of the coagulase negative Staphylococcus mecA-positives for: penicillin G, amoxicillin-ampicillin, cefazolin, ampicillin-sulbactam, erythromycin, clindamycin, gentamicin and tetracycline (P< or =0.05). All coagulase negative Staphylococcus species were susceptible to vancomycin and there was no statistically significant correlation between the mecA-positive isolates and resistance to trimethoprim-sulfamethoxazole or to rifampin.

CONCLUSIONS

In the present study, we found that the E-test and the oxacillin salt agar screening test S (0.75 microg oxacillin per ml), when compared with polymerase chain reaction, were the most accurate currently available methods to phenotypically detect oxacillin resistance of coagulase negative Staphylococcus species. This study demonstrated that a good option for screening of ocular isolates for oxacillin resistance in the microbiology laboratory is the cefoxitin disk diffusion test and the automated Vitek system. We believe it is important to have available methods that accurately detect methicillin resistance of the less commonly encountered species, chiefly because of their increasing importance as opportunistic pathogens.

Restoration of antibiotic susceptibility in methicillin-resistant Staphylococcus aureus by targeting mecR1 with a phosphorothioate deoxyribozyme

1. Methicillin resistance in Staphylococcus aureus is mediated by the mecA gene. The mecA gene encodes a penicillin-binding protein (PBP2a) possessing low beta-lactam affinity. Transcription of mecA is regulated by a signal transduction system consisting of the sensor/transducer MecR1. Disruption of the MecR1 regulatory pathway may inhibit mecA expression and restore methicillin-resistant Staphylococcus aureus (MRSA) susceptibility to beta-lactams. 2. In the present study, a phosphorothioate deoxyribozyme (named PS-DRz147) specifically targeting MecR1 mRNA was designed, synthesised and introduced into the MRSA strain WHO-2. 3. The expression of mecR1 and mecA was inhibited by PS-DRz147 in a concentration-dependent manner. Consequently, the susceptibility of WHO-2 colonies to the antibiotic oxacillin was restored. 4. The results of the present study indicate that blockade of the MecR1-MecI-MecA signalling pathway with an mecR1-targeted DNAzyme can restore the susceptibility of MRSA to existing beta-lactam antibiotics.

Molecular typing of Staphylococcus aureus clinical isolates by pulsed-field gel electrophoresis, staphylococcal cassette chromosome mec type determination and dissemination of antibiotic resistance genes

Pulsed-field gel electrophoresis (PFGE) of SmaI macrorestriction fragments of genomic DNA as well as staphylococcal cassette chromosome mec (SCCmec) typing for mecA-carrying isolates were used to study the distribution of clonal types among 177 Staphylococcus aureus clinical isolates recovered in a Spanish hospital between 2000 and 2003. Five major clonal types (P1 to P5) were identified by PFGE, with one of them (P1) comprising the majority of strains (47.5%). According to SCCmec typing, SCCmec type IVA was the most prevalent type, showing increasing prevalence in the hospital setting with respect to other pandemic clones. One SCCmec pattern was detected in different PFGE types, which demonstrates that the latter is a major discriminative typing method. Three novel SCCmec elements or variants were found, each in a different PFGE type. Oxacillin (methicillin)-resistant and -susceptible S. aureus (MRSA and MSSA, respectively) strains were detected showing identical PFGE patterns, suggesting horizontal transfer of mecA to MSSA and/or mecA deletion from MRSA. Persistence of several S. aureus clones throughout the years within the same hospital environment was also observed.

Antistaphylococcal activity of CG400549, a new experimental FabI inhibitor, compared with that of other agents

Among 203 strains of Staphylococcus aureus, the MICs of CG400549 were 0.06 to 1.0 microg/ml, with MIC(50) and MIC(90) values of 0.25 microg/ml each. All strains were susceptible to linezolid and quinupristin-dalfopristin (MICs, 0.25 to 2.0 microg/ml). The daptomycin MICs were 0.25 to 2.0 microg/ml for methicillin-susceptible and 0.25 to 4.0 microg/ml against methicillin-resistant strains (including vancomycin-intermediate strains). Single-passage selection testing showed low resistance frequencies with CG400549, but multistep analysis showed that CG400549 yielded resistant mutants after 14 to 17 days in all strains tested.

Detection and characterization of international community-acquired infections by methicillin-resistant Staphylococcus aureus clones in Rio de Janeiro and Porto Alegre cities causing both community- and hospital-associated diseases

Community-acquired infections by methicillin-resistant Staphylococcus aureus (CA-MRSA) in the absence of classic risk factors for MRSA diseases have been reported in different continents. In the article presented here, using molecular typing methods as pulsed-field gel electrophoresis, staphylococcal cassette chromosome mec typing, and multilocus sequence typing, we characterized CA-MRSA isolates from Rio Janeiro and Porto Alegre. The results indicated the presence of international CA-MRSA clones in these 2 Brazilian cities. In addition, Panton-Valentine leukocidin and a number of staphylococcal enterotoxin encoding genes were accessed in these MRSA isolates by polymerase chain reaction detection.

Detection of diverse SCCmec variants in methicillin-resistant Staphylococcus aureus and comparison of SCCmec typing methods

Non-duplicate methicillin-resistant Staphylococcus aureus (MRSA) isolates (n = 436), collected from four hospitals located in three Korean cities between 2001 and 2005, were investigated by SCCmec typing and multilocus sequence typing (MLST). Variations within SCCmec, especially type II, were detected in 165 (37.8%) isolates, and these variants were characterised using four different SCCmec typing methods. The predominant SCCmec type was a type II variant that differed from type II by the absence of a pUB110 insertion. MLST analysis showed that most of the isolates carrying SCCmec variants belonged to ST5.

A study of the efficacy and cost-effectiveness of MRSA screening and monitoring on surgical wards using a new, rapid molecular test (EMMS)

BACKGROUND

MRSA is a significant contributor to prolonged hospital stay, poor clinical outcome and increased healthcare costs amongst surgical patients. A PCR test has been developed for rapid detection of MRSA in nasal swabs. The aims of this study are (1) to estimate the effectiveness of screening using this rapid PCR tests vs culture in reducing MRSA cross-infection rates; (2) to compare the cost of each testing strategy, including subsequent health care costs; and (3) to model different policies for the early identification and control of MRSA infection in surgical patients.

METHODS/DESIGN

The study is a prospective two-period cross-over study set in 7 surgical wards covering different surgical specialities. A total of 10,000 patients > 18 years will be tested over 16 months. The only difference between the two study periods is the method used for the detection of MRSA in each ward (rapid v conventional culture), with all other infection control practices remaining consistent between the arms. The study has been designed to complement routine practice in the NHS. Outcomes are MRSA cross-infection rates (primary outcome) and need for antibiotic therapy and MRSA-related morbidity. Parallel economic and modelling studies are being conducted to aid in the interpretation of the results and to evaluate the cost-effectiveness of the rapid PCR screening strategy.

DISCUSSION

This paper highlights the design, methods and operational aspects of a study evaluating rapid MRSA screening in the surgical ward setting.

[Comparison of phenotypic methods with PCR to screening methicillin resistance in coagulase negative staphylococci]

THE AIM OF STUDY

Appreciation of the frequency, the level and the genetic support of methicillin resistance.

MATERIAL AND METHODS

Seventy-three strains of coagulase negative staphylococci isolated from various specimens, from January to June 2004, were studied. The phenotypic detection was carried out by disk diffusion test using oxacillin and cefoxitin disks, by the determination of oxacillin Minimal Inhibitor Concentration (E-test), by the oxacillin screening test at a concentration of 4 mug/ml and by the search of the penicillin binding protein PBP2a using the slide latex agglutination test. The results of these methods were compared to PCR of mecA gene.

RESULTS

Forty-eight strains carried mecA gene whose 30 were detected by the oxacillin disk, the cefoxitin disk, the oxacillin screening test, the slide latex agglutination test and had a MIC from 24 to 256 mug/ml. Seventeen strains were not detected by oxacillin disk but by cefoxitin disk and the slide latex agglutination test. Among these strains, 13 (76%) had oxacillin MIC from 0.5 to 1,5 mug/ml and not grew on oxacillin agar screening, while 4 (24%) had oxacillin MIC from 6 to 16 mug/ml and grew on this agar. One strain had oxacillin MIC of 0,19 mug/ml and was not detected with any phenotypic method.

CONCLUSION

The determination of oxacillin MIC, the search of the PBP2a or more simply the cefoxitin disk had permitted to detect the strains mecA gene (+) with resistant and pre-resistant phenotype but not the strain with sensible phenotype (2.1%).

Distribution of staphylococcal cassette chromosome mec (SCCmec) types I, II, III and IV in coagulase-negative staphylococci from patients attending a tertiary hospital in southern Brazil

Coagulase-negative staphylococci (CoNS) are now recognized as the aetiological agents of an important range of infections in humans. Most developed countries have reported an increase in CoNS infections in hospitalized patients that are resistant to meticillin and other antibiotics. Staphylococcal cassette chromosome mec (SCCmec) typing is essential for understanding the molecular epidemiology of meticillin-resistant Staphylococcus strains. SCCmec elements are currently classified into types I to VI based on the characteristics of the mec and ccr gene complexes and are further classified into subtypes according to their ‘junkyard DNA’ region. We evaluated the distribution of SCCmec types in CoNS from patients attending the Hospital de Clínicas de Porto Alegre over the period August 2004–December 2005. Among the 129 bloodstream isolates, 36 (27.9 %) harboured SCCmec type I, 4 (3.0 %) harboured SCCmec type II, 67 (52 %) harboured SCCmec type III, 1 (0.8 %) harboured SCCmec type IV and 4 (3.0 %) harboured SCCmec types I and III. Seventeen isolates were not typable. Identification of CoNS at the species level indicated that Staphylococcus epidermidis was the most common species, with 87 isolates, followed by Staphylococcus haemolyticus (15), Staphylococcus hominis (13), Staphylococcus capitis (12) and Staphylococcus sciuri (1). SCCmec type III was the most prevalent among isolates of S. epidermidis (52 %). Among these strains, 30 (23 %) harboured a modified SCCmec type III which contained an additional dcs region in comparison with regular type III. SCCmec type III was also highly prevalent (75 %) among S. capitis isolates. The predominant SCCmec type found among S. haemolyticus isolates was type I. However, all four isolates harbouring SCCmec type II belonged to S. haemolyticus. Our results indicate that SCCmec type III was the most prevalent among the CoNS. Isolates with SCCmec type III were more resistant to non-β-lactam antimicrobials than isolates harbouring SCCmec types I, II and IV, although the increase in resistance was statistically significant only for clindamycin (P=0.021), rifampicin (P=0.010) and levofloxacin (P=0.005).

Replacement of methicillin-resistant Staphylococcus aureus clones in Hungary over time: a 10-year surveillance study

The prevalence of methicillin-resistant Staphylococcus aureus (MRSA) in Hungary has been increasing and is now close to 20% among invasive isolates of S. aureus. In order to understand the evolution of MRSA in Hungary, two collections of isolates were studied: 22 representatives of a collection of 238 MRSA isolates recovered between 1994 and 1998, and a collection of 299 MRSA isolates recovered between 2001 and 2004. The isolates were first characterised by pulsed-field gel electrophoresis (PFGE) and were distributed into 19 different PFGE patterns. Representatives of each pattern were further characterised by spa typing, multilocus sequence typing (MLST) and staphylococcal cassette chromosome mec (SCCmec) typing. The Hungarian clone that was predominant in 1994-1998 (PFGE E, ST239-III) had almost disappeared in 2003-2004, being replaced by the Southern German clone (PFGE B, ST228-I) and the New York/Japan epidemic clone (PFGE A, ST5-II), which represented c. 85% of the 2001-2004 isolates. Thus, this study describes, for the first time, the co-dominance and extensive spread of the New York/Japan clone in a European country.

High density whole genome fingerprinting of methicillin-resistant and -susceptible strains of Staphylococcus aureus in search of phenotype-specific molecular determinants

AFLP is a selective restriction fragment amplification method generating DNA fingerprints for microbial isolates. We present high-throughput AFLP (htAFLP) to characterize molecular markers associated with bacterial phenotypes. Methicillin-resistant and -susceptible isolates of Staphylococcus aureus have been used for this model study in conjunction with the available S. aureus genome sequences. This facilitates the calculation of theoretical AFLP fingerprints, comparison of these fingerprints with genuine experimental fingerprints, and the subsequent identification of polymorphic AFLP markers without sequence analysis. Analysis of 46 MRSA and 46 MSSA strains by 39 different AFLP reactions generated more than 2500 fragments per strain and an overall number of 6180 scorable markers within all strains. We successfully identify MRSA specific markers and elaborate on the general applicability of the htAFLP approach. This method can be applied to any microbial species for which at least one full-genome sequence is available.

Population genetic structure of the Staphylococcus intermedius group: insights into agr diversification and the emergence of methicillin-resistant strains

The population genetic structure of the animal pathogen Staphylococcus intermedius is poorly understood. We carried out a multilocus sequence phylogenetic analysis of isolates from broad host and geographic origins to investigate inter- and intraspecies diversity. We found that isolates phenotypically identified as S. intermedius are differentiated into three closely related species, S. intermedius, Staphylococcus pseudintermedius, and Staphylococcus delphini. S. pseudintermedius, not S. intermedius, is the common cause of canine pyoderma and occasionally causes zoonotic infections of humans. Over 60 extant STs were identified among the S. pseudintermedius isolates examined, including several that were distributed on different continents. As the agr quorum-sensing system of staphylococci is thought to have evolved along lines of speciation within the genus, we examined the allelic variation of agrD, which encodes the autoinducing peptide (AIP). Four AIP variants were encoded by S. pseudintermedius isolates, and identical AIP variants were shared among the three species, suggesting that a common quorum-sensing capacity has been conserved in spite of species differentiation in largely distinct ecological niches. A lack of clonal association of agr alleles suggests that assortive recombination may have contributed to the distribution of agr diversity. Finally, we discovered that the recent emergence of methicillin-resistant strains was due to multiple acquisitions of the mecA gene by different S. pseudintermedius clones found on different continents. Taken together, these data have resolved the population genetic structure of the S. intermedius group, resulting in new insights into its ancient and recent evolution.

Transduction of the plasmid encoding antiseptic resistance gene qacB in Staphylococcus aureus

The plasmid-borne qacA and qacB genes encode a multidrug efflux protein. The proteins encoded by qacA and qacB mediate efflux of cationic antiseptic agents such as quaternary ammonium compounds. In methicillin-resistant Staphylococcus aureus (MRSA), qacA and qacB are widely prevalent and decrease antiseptic susceptibility. However, it is difficult to find the plasmids encoding qacA or qacB in community-associated MRSA (C-MRSA) isolated from patients with impetigo. Most MRSA, the strains causative of impetigo, carry the plasmid-borne exfoliative toxin-producing gene etb. To find the reason for the paucity of qacA or qacB in MRSA isolated from patients with impetigo, we performed transfer experiments of the plasmid pTZ2162qacB encoding qacB. The pTZ2162qacB was transferred to S. aureus strain RN4220 by transduction, although no pTZ2162qacB was transferred by conjugation. Additionally, pTZ2162qacB was transduced to MRSA carrying etb, and was coexistence with the plasmid encoding etb. Our results showed that pTZ2162qacB was horizontally transferred by transduction and was compatible with the plasmid encoding etb. Consequently, there will be risk of the emergence of C-MRSA with decreased antiseptic susceptibility among patients with impetigo.

Virulence determinants in community and hospital meticillin-resistant Staphylococcus aureus

Staphylococcus aureus produces many virulence factors, most of which act in a synergistic and coordinated fashion. Some appear to be specifically associated with certain severe infections and are produced by meticillin-resistant Staphylococcus aureus (MRSA) clones distributed worldwide. Superantigenic exotoxins appear to be major virulence factors in hospital MRSA clones (HA-MRSA), and staphylococcal enterotoxin A (SEA) may be involved in the physiopathology of septic shock. Panton Valentine Leucocidin (PVL) has emerged as a major virulence factor in community-acquired Staphylococcus aureus (CA-MRSA) infections. In particular, the leukotoxic action of PVL is responsible for the high mortality rate associated with necrotizing pneumonia. CA-MRSA can also harbour the toxic shock toxin 1 (TSST-1) and rarely the exfoliative toxin.

Evaluation of oxacillin and cefoxitin disks for detection of resistance in coagulase negative staphylococci

Coagulase-negative Staphylococcus spp. was considered nonpathogenic until the emergence of multiresistance and the demonstration of their participation as infectious agents. In Brazil, oxacillin resistance may be present in over 80% of isolates, and the Clinical and Laboratory Standards Institute standardized a disk-diffusion method to predict this resistance in Staphylococcus. The aim of this study was to evaluate the variability among commercial disks of oxacillin (1 microg) and cefoxitin (30 microg) widely used in clinical laboratories of microbiology, compared with mecA gene and minimum inhibitory concentration (MIC) of oxacillin. The use of oxacillin and cefoxitin disks simultaneously allowed the detection of important differences, particularly, in less frequent species such as S. cohnii, S. haemolyticus, S. saprophyticus, and S. sciuri. Disks of cefoxitin of the brand 2 displayed good correlation with the mecA gene (98.7%) and oxacillin MIC (97.8%), while major discrepancies were observed using disks of brand 1. One of the critical points in the diffusion disk test is the quality of the disks: the use of better quality disks associated with molecular methods lead to better results to define the best antibiotic therapy.