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Antimicrobial Agents and Chemotherapy, December 2003, p. 3926-3934, Vol. 47, No. 12
0066-4804/03/$08.00+0     DOI: 10.1128/AAC.47.12.3926-3934.2003
Copyright © 2003, American Society for Microbiology. All Rights Reserved.

Evolutionary Models of the Emergence of Methicillin-Resistant Staphylococcus aureus

D. Ashley Robinson and Mark C. Enright*

Department of Biology and Biochemistry, University of Bath, Bath BA2 7AY, United Kingdom

Received 23 May 2003/ Returned for modification 1 August 2003/ Accepted 8 September 2003

Five major lineages of methicillin-resistant Staphylococcus aureus (MRSA) have evolved since the introduction of methicillin for the treatment of infections caused by penicillin-resistant S. aureus in 1959. The clones of these lineages are responsible for the vast majority of hospital-acquired MRSA disease globally. We have constructed high-resolution evolutionary models for each lineage using a parsimony approach with 15 partial gene sequences from 147 geographically diverse isolates. On the basis of these models, we infer that MRSA has emerged at least 20 times upon acquisition of the methicillin resistance determinant, which is carried on a mobile genetic element called the staphylococcal cassette chromosome mec (SCCmec). The acquisition of SCCmec by sensitive clones was four times more common than the replacement of one SCCmec with another. Notably, SCCmec type IV was found in twice as many clones as any other SCCmec type, and it is this SCCmec type which is commonly found in clones from patients with community-acquired MRSA disease. Our findings suggest that most clones of MRSA arise by the acquisition of SCCmec type IV by methicillin-sensitive isolates.

* Corresponding author. Mailing address: Department of Biology and Biochemistry, University of Bath, Claverton Down, Bath BA2 7AY, United Kingdom. Phone: 44-1225-386871. Fax: 44-1225-386779. E-mail: m.c.enright{at}bath.ac.uk.

Antimicrobial Agents and Chemotherapy, December 2003, p. 3926-3934, Vol. 47, No. 12
0066-4804/03/$08.00+0     DOI: 10.1128/AAC.47.12.3926-3934.2003
Copyright © 2003, American Society for Microbiology. All Rights Reserved.



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