Frequent Recovery of a Single Clonal Type of Multidrug-Resistant
            <i>Staphylococcus aureus</i>
            from Patients in Two Hospitals in Taiwan and China

Aires-de-Sousa, Marta; Crisóstomo, M. Inês; Sanches, Ilda Santos; Wu, Jian-Yong; Fuzhong, J.; Tomasz, Alexander; Lencastre, Hermı́nia de

doi:10.1128/jcm.41.1.159-163.2003

Cited by 114 publications

(89 citation statements)

References 26 publications

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“…Most of the MRSA isolates belonging to ST239 from India, Indonesia, Singapore, Sri Lanka, Taiwan, and Greece were resistant to SXT (1,3,16), while those from China, Vietnam, and the Czech Republic were susceptible (3,16,17). These data, combined with our current results, suggest that the susceptibility of MRSA isolates belonging to ST239 to SXT is different between the bacterial isolation sites.…”

Section: Resultssupporting

confidence: 75%

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Prevalence of the ST239 Clone of Methicillin-Resistant Staphylococcus aureus and Differences in Antimicrobial Susceptibilities of ST239 and ST5 Clones Identified in a Korean Hospital

Yun¹,

Moon²,

Choi³

et al. 2005

J Clin Microbiol

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A total of 188 nonduplicate methicillin-resistant Staphylococcus aureus (MRSA) isolates obtained between 2001 and 2004 in a university hospital in Daegu, Korea, were analyzed for their clonal types by molecular typing techniques, including multilocus sequence typing, spaA typing, staphylococcal chromosomal cassette mec (SCCmec) typing, and pulsed-field gel electrophoresis (PFGE). They were examined for their antimicrobial susceptibilities. The majority (87%) of MRSA isolates belonged to sequence type 239 (ST239; n ‫؍‬ 100; 53%) and ST5 (n ‫؍‬ 63, 34%) on the basis of sequence typing. MRSA isolates belonging to ST239 were genotypically homogeneous, while those belonging to ST5 showed variations in spaA type, SCCmec type, and PFGE patterns. The rates of resistance of the MRSA isolates belonging to ST239 to trimethoprim, sulfamethoxazole, tobramycin, gentamicin, erythromycin, and tetracycline were significantly higher than those of the isolates belonging to ST5 (P < 0.05). This study demonstrated that the ST239 clone, while rarely detected in Korea, was prevalent and that the antimicrobial susceptibility of the ST239 clone was significantly different from that of the ST5 clone.

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Section: Resultssupporting

confidence: 75%

“…Phylogenetic studies by molecular typing techniques have shown that only a few epidemic MRSA clones are responsible for the large proportion of MRSA infections worldwide (3,6,8,10,23,25,30). Five major internationally spread epidemic MRSA clones, the Iberian (7,12,27), Brazilian (31), Hungarian (6,22), New York/Japan (2,24), and pediatric (26) 2004.…”

mentioning

confidence: 99%

Prevalence of the ST239 Clone of Methicillin-Resistant Staphylococcus aureus and Differences in Antimicrobial Susceptibilities of ST239 and ST5 Clones Identified in a Korean Hospital

Yun¹,

Moon²,

Choi³

et al. 2005

J Clin Microbiol

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“…There is a good correlation between clonal groupings determined by MLST and the respective spa types (3,4,23,24). Examples have been reported of isolates with the same spa type belonging to related MLST sequence types that arose by single-locus variation (5). On the other hand, there seems to be a considerable degree of spa gene repeat number variation within a given sequence type, suggesting that spa typing in some instances provides greater resolution than MLST (3,23).…”

mentioning

confidence: 88%

Typing of Methicillin-Resistant Staphylococcus aureus in a University Hospital Setting by Using Novel Software for spa Repeat Determination and Database Management

et al. 2003

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The spa gene of Staphylococcus aureus encodes protein A and is used for typing of methicillin-resistant Staphylococcus aureus (MRSA). We used sequence typing of the spa gene repeat region to study the epidemiology of MRSA at a German university hospital. One hundred seven and 84 strains were studied during two periods of 10 and 4 months, respectively. Repeats and spa types were determined by Ridom StaphType, a novel software tool allowing rapid repeat determination, data management and retrieval, and Internet-based assignment of new spa types following automatic quality control of DNA sequence chromatograms. Isolates representative of the most abundant spa types were subjected to multilocus sequence typing and pulsed-field gel electrophoresis. One of two predominant spa types was replaced by a clonally related variant in the second study period. Ten unique spa types, which were equally distributed in both study periods, were recovered. The data show a rapid dynamics of clone circulation in a university hospital setting. spa typing was valuable for tracking of epidemic isolates. The data show that disproval of epidemiologically suggested transmissions of MRSA is one of the main objectives of spa typing in departments with a high incidence of MRSA.Staphylococcus aureus is a major human pathogen causing skin and tissue infections, pneumonia, septicemia, and deviceassociated infections. The emergence of strains resistant to methicillin and other antibacterial agents has become a major concern especially in the hospital environment, because of the higher mortality due to systemic methicillin-resistant Staphylococcus aureus (MRSA) infections (2). Typing of MRSA is used to support infection control measures. While pulsed-field gel electrophoresis (PFGE) is a "gold standard" for strain typing of MRSA (20), DNA sequence-based approaches are becoming more frequently used because sequence data can easily be transferred between laboratories via the Internet. Multilocus sequence typing (MLST), which was developed by using Neisseria meningitidis as the model species (9, 18), has been successfully adapted to S. aureus (7,8). However, MLST is not suitable for routine surveillance of MRSA because of the high cost and the necessity of access to a high-throughput DNA sequencing facility.Although there is evidence for recombination in S. aureus (10), it has been shown that point mutations by far exceed recombination events, in contrast to N. meningitidis or Streptococcus pneumoniae (11). Furthermore, there is only a small number of clonal groupings of MRSA circulating worldwide (7). Therefore, single-locus DNA sequencing of repeat regions of the coa (coagulase) gene and the spa gene (protein A), respectively, could be used for reliable and accurate typing of MRSA (12,13,(26)(27)(28)(29). spa typing is especially interesting for rapid typing of MRSA in a hospital setting since it offers higher resolution than coa typing (27). The repeat region of the spa gene is subject to spontaneous mutations, as well as loss and gain of repeats. ...

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“…42, 2004 DISCRIMINATION AMONG S. AUREUS ISOLATES BY spa TYPING 797 the thousands of S. aureus isolates that we have attempted to spa type was typeable. Use of the alternative primer used in this study for MSA 2389 is suggested in the very rare instances of no spa amplification (8,26), which are likely due to sequence mutations in the primer region. In order to understand why spa typing is so highly discriminating, it is important to analyze two major contributory components of discriminatory power in a sequence-based VNTR typing system: the background rate of nucleotide mutation within the repeats and the extent of repeat number variation (i.e., variability in repeat region size).…”

Section: Discussionmentioning

confidence: 99%

spa Typing Method for Discriminating among Staphylococcus aureus Isolates: Implications for Use of a Single Marker To Detect Genetic Micro- and Macrovariation

et al. 2004

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Strain typing of microbial pathogens has two major aims: (i) to index genetic microvariation for use in outbreak investigations and (ii) to index genetic macrovariation for use in phylogenetic and population-based analyses. Until now, there has been no clear indication that one genetic marker can efficiently be used for both purposes. Previously, we had shown that DNA sequence analysis of the protein A gene variable repeat region (spa typing) provides a rapid and accurate method to discriminate Staphylococcus aureus outbreak isolates from those deemed epidemiologically unrelated. Here, using the hypothesis that the genetic macrovariation within a low-level recombinogenic species would accurately be characterized by a single-locus marker, we tested whether spa typing could congruently index the extensive genetic variation detected by a whole-genome DNA microarray in a collection of 36 isolates, which was recovered from 10 countries on four continents over a period of four decades, that is representative of the breadth of diversity within S. aureus. Using spa and coa typing, pulsed-field gel electrophoresis (PFGE), and microarray and multilocus enzyme electrophoresis (MLEE) data in molecular epidemiologic and evolutionary analyses, we determined that S. aureus likely has a primarily clonal population structure and that spa typing can singly index genetic variation with 88% direct concordance with the microarray and can correctly assign isolates to phylogenetic lineages. spa typing performed better than MLEE, PFGE, and coa typing in discriminatory power and in the degree of agreement with the microarray at various phylogenetic depths. This study showed that genetic analysis of the repeat region of protein A comprehensively characterizes both micro-and macrovariation in the primarily clonal population structure of S. aureus.Staphylococcus aureus is the leading cause of nosocomial infections (21) and is responsible for a wide range of human diseases, including endocarditis, food poisoning, toxic shock syndrome, septicemia, skin infections, soft tissue infections, and bone infections, as well as bovine and ovine mastitis. The recent emergence of community-associated methicillin-resistant S. aureus (MRSA) strains (23) and the movement of the vanA operon from Enterococcus faecalis into MRSA, establishing strains with high-level vancomycin resistance (3), further heighten the public health concerns. Thus, understanding and controlling the spread of S. aureus, in both the hospital and community settings, is now of paramount importance.S. aureus is a heterogenous (polymorphic) species (13) that was recently found to have a clonal population structure (11). Therefore, it is believed that S. aureus does not undergo extensive recombination, diversifies largely by nucleotide mutations, and shows a high degree of linkage disequilibrium (nonrandom associations between genetic loci). In order to distinguish strains within a heterogenous species for local epidemiologic or outbreak investigation purposes, a highly discriminating ge...

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Frequent Recovery of a Single Clonal Type of Multidrug-Resistant Staphylococcus aureus from Patients in Two Hospitals in Taiwan and China

Cited by 114 publications

References 26 publications

Prevalence of the ST239 Clone of Methicillin-Resistant Staphylococcus aureus and Differences in Antimicrobial Susceptibilities of ST239 and ST5 Clones Identified in a Korean Hospital

Prevalence of the ST239 Clone of Methicillin-Resistant Staphylococcus aureus and Differences in Antimicrobial Susceptibilities of ST239 and ST5 Clones Identified in a Korean Hospital

Typing of Methicillin-Resistant Staphylococcus aureus in a University Hospital Setting by Using Novel Software for spa Repeat Determination and Database Management

spa Typing Method for Discriminating among Staphylococcus aureus Isolates: Implications for Use of a Single Marker To Detect Genetic Micro- and Macrovariation

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