1887

Abstract

Four community-associated meticillin-resistant (CA-MRSA) isolates expressing high-level mupirocin resistance (MIC >1024 mg l) were isolated from four sites of a diabetic patient and characterized for the genetic location of their resistance determinants and typed using PFGE, staphylococcal cassette chromosome (SCC), the coagulase gene and multilocus sequence typing to ascertain their relatedness. The presence of genes for resistance to high-level mupirocin (), tetracycline () and fusidic acid (), Panton–Valentine leukocidin (PVL), accessory gene regulators () and capsular polysaccharide () were detected in PCR assays. The isolates were resistant to kanamycin, streptomycin, tetracycline, fusidic acid and cadmium acetate, and harboured , , , PVL, and . They had identical PFGE patterns and coagulase gene type, possessed the type IV SCC element and belonged to sequence type 80 (ST80). However, they had three different plasmid profiles: (i) 28.0 and 26.0 kb; (ii) 28.0, 21.0 and 4.0 kb; and (iii) 41.0 and 4.0 kb. Genetic studies located the resistance to tetracycline, fusidic acid and cadmium acetate on the 28 kb plasmid and on the related non-conjugative 26 and 21 kb plasmids. One of the 21 kb mupirocin-resistance plasmids was derived from the ∼41 kb plasmid during transfer experiments. The emergence of high-level mupirocin resistance in the ST80-SCC IV MRSA clone demonstrates the increasing capacity of CA-MRSA clones to acquire resistance to multiple antibacterial agents. The presence of different plasmid profiles in genetically identical isolates creates difficulty in the interpretation of typing results and highlights the weakness of using plasmid analysis as the sole method for strain typing.

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2010-02-01
2024-03-29
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