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Antimicrobial Agents and Chemotherapy, December 2007, p. 4342-4350, Vol. 51, No. 12
0066-4804/07/$08.00+0     doi:10.1128/AAC.01414-06
Copyright © 2007, American Society for Microbiology. All Rights Reserved.

Molecular and Epidemiological Evidence for Spread of Multiresistant Methicillin-Susceptible Staphylococcus aureus Strains in Hospitals

Pierre-Yves Donnio,^1,2* Frédéric Février,³ Pablo Bifani,⁴ Marie Dehem,⁵ Christèle Kervégant,¹ Nathalie Wilhelm,³ Anne-Lise Gautier-Lerestif,^1,2 Nathalie Lafforgue,^1,2 Michel Cormier,^1,2 the MR-MSSA Study Group of the Collège de Bactériologie-Virologie-Hygiène des Hôpitaux de France Alain Le Coustumier,³

Département de Bactériologie-Virologie et Hygiène Hospitalière, Centre Hospitalier Universitaire, 35033 Rennes, France,¹ UPRES-1254 Microbiologie, Université Rennes I, 35043 Rennes, France,² Laboratoire de Biologie, Centre Hospitalier, 46005 Cahors, France,³ Pasteur Institute, B-1180 Brussels, Belgium,⁴ Genoscreen, 59000 Lille, France⁵

Received 20 November 2006/ Returned for modification 26 January 2007/ Accepted 10 August 2007

The excision of the staphylococcal chromosomal cassette mec (SCCmec) from methicillin-resistant Staphylococcus aureus (MRSA) strains results in methicillin-susceptible S. aureus (MSSA) strains. In order to determine the proportion and diversity of multidrug-resistant MSSA (MR-MSSA) strains derived from MRSA strains, 247 mecA-negative isolates recovered in 60 French hospitals between 2002 and 2004 were characterized. The spa types of all strains were determined, and a subset of the strains (n = 30) was further genotyped by multilocus sequence typing. The IDI-MRSA assay was used to test the isolates for the presence of the SCCmec element, which was detected in 68% of all isolates analyzed. Molecular analysis of the samples suggested that 92% of the MR-MSSA isolates were derived from MRSA clones of diverse genetic backgrounds, of which the clone of sequence type 8 and SCCmec type IV_A accounted for most of the samples. High variations in incidence data and differences in the molecular characteristics of the isolates from one hospital to another indicate that the emergence of MR-MSSA resulted from independent SCCmec excisions from epidemic MRSA isolates, as well as the diffusion of methicillin-susceptible strains after the loss of SCCmec. MR-MSSA could constitute a useful model for the study of the respective genetic and environmental factors involved in the dissemination of S. aureus in hospitals.

Published ahead of print on 20 August 2007.

Members of the MR-MSSA Study Group are microbiologists from hospitals in Antibes (V. Blanc), Arles (K. Krechiem), Arras (M. Marcolin, M. N. Noulard), Aulnay-sous-Bois (H. Porcheret), Aurillac (M. Villemain), Avranches (D. Siep Heng, P. Deprez), Bagnols-sur-Cèze (G. Khatib), Bayeux (J. Carre, E. Heusse), Belley (O. Sabot), Béthune (S. Dekeyser, D. Descamps), Béziers (L. Gazagne), Bourg-en-Bresse (F. Laurent), Cannes (D. Neri-Schiavini, F. Carmagnol), Châlons-en-Champagne (I. Baudinat), Charleville-Mézières (C. Auvray, S. Delesalle), Dax (J. P. Lafargue), Douai (S. Hendricx), Dourdan (J. W. Decousser, A. Sarran), Dunkerque (A. Verhaeghe), Elbeuf (G. Grise), Falaise (G. Gallou), Foix-Pamiers (A. Clarac-Panisello), Fort-de-France (C. Olive, R. Theodose), Gonesse (D. Barraud, M. Terki), Langres (D. Simeon), Lannion (J. L. Laborie), La Roche-sur-Yon (G. Chambreuil, A. S. Poirier), Le Mans (A. Marmonnier, C. Varache), Lorient (J. F. Ygout), Mantes-La Jolie (L. Berardi-Grassias, F. Richardin), Marseille (P. Brunet, A. Michel), Maubeuge (M. Vasseur), Metz (J. Didion, Y. Rio), Meulan (E. Vallee), Monaco (S. Gabriel, P. Sorlin), Montceau-les-Mines (O. Menouni), Montreuil-sur-Mer (M. Menouar), Montluçon (S. Laluque), Mulhouse (J. M. Delarbre), Nemours (P. Guiet), Neufchateau (M. Thouvenin), Orléans (D. Poisson, L. Bret), Orsay (B. Ferre, B. Mounkassa), Perpignan (P. Gueudet, E. Lecaillon), Poissy (M. Leneveu, G. Rast), Provins (C. Durand, F. Pateyron), Quimper (F. Geffroy), Quimperlé (A. Valogne), Sablé-sur-Sarthe (S. Fosse-Ledinger, E. Jaouen), Sallanches (P. Clergeau), Saint-Brieuc (J. Vaucel), Saint-Denis de la Réunion (C. Denoix, M. C. Jaffar), Saint-Etienne Clinique Mutualiste (R. Meley), Saint-Germain-en-Laye (M. Cheron, E. Vallee), Saumur (E. Bichier), Seclin (C. Rolland), Sète (A. Barrans, B. Lamy), Thionville (M. Perrin), Troyes (C. Eloy), Vannes (P. Pouedras), Versailles (B. Pangon), and Vesoul (P. Chantelat).