title: Emergence and spread in French hospitals of methicillin-resistant Staphylococcus aureus with increasing susceptibility to gentamicin and other antibiotics.
abstract: Oxacillin (methicillin) resistance in methicillin-resistant Staphylococcus aureus (MRSA) is associated with an increased incidence of resistance to other antibiotics, which has increased since it was first reported in 1969. In 1992 a new phenotype of MRSA arose in France; this was characterized by a heterogeneous expression of resistance to oxacillin and susceptibility to various antibiotics, including gentamicin but also tetracycline, minocycline, lincomycin, pristinamycin, co-trimoxazole, rifampin, and fusidic acid. In French hospitals a longitudinal nationwide surveillance of antibiotic resistance in S. aureus has allowed for the detection of changes in antibiotic susceptibility profiles. Seven French clinical laboratories (six from the mainland and one from the West Indies) reported the results of susceptibility testing of 57,347 S. aureus strains isolated in their institutes between 1992 and 1998. Over a 7-year period the incidence of isolation of gentamicin-susceptible MRSA (GS-MRSA) strains has steadily increased to represent, in 1998, 46.8 to 94.4% of the MRSA strains, irrespective of the overall incidence of MRSA. Two predominant types recognized by pulsed-field gel electrophoresis (PFGE) accounted for the majority of the GS-MRSA in different mainland hospitals, both differing from the predominant type observed in the French West Indies. Some GS-MRSA and gentamicin-resistant MRSA (GR-MRSA) strains had closely related PFGE profiles, and hybridization studies confirmed the lack in GS-MRSA of the aac6'-aph2" gene, which confers resistance to all aminoglycosides, with conservation of the ant4' gene, which confers resistance to kanamycin, tobramycin, and amikacin. Thus, it is likely that certain GS-MRSA strains could have emerged from GR-MRSA strains by excision or deletion of the aac6'-aph2" gene.
authors.affiliation: Centre National de Référence des Toxémies à Staphylocoques, EA 1655, Faculté de Médecine, 69372 Lyon Cedex 08, France.
authors.forename: H
authors.initials: H
authors.lastname: Lelièvre
authors.forename: G
authors.initials: G
authors.lastname: Lina
authors.forename: M E
authors.initials: ME
authors.lastname: Jones
authors.forename: C
authors.initials: C
authors.lastname: Olive
authors.forename: F
authors.initials: F
authors.lastname: Forey
authors.forename: M
authors.initials: M
authors.lastname: Roussel-Delvallez
authors.forename: M H
authors.initials: MH
authors.lastname: Nicolas-Chanoine
authors.forename: C M
authors.initials: CM
authors.lastname: Bébéar
authors.forename: V
authors.initials: V
authors.lastname: Jarlier
authors.forename: A
authors.initials: A
authors.lastname: Andremont
authors.forename: F
authors.initials: F
authors.lastname: Vandenesch
authors.forename: J
authors.initials: J
authors.lastname: Etienne
mesh_terms: D003428:Cross Infection / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology; D004352:Drug Resistance, Microbial / Q000235:genetics; D018432:Drug Resistance, Multiple / Q000235:genetics; D016521:Electrophoresis, Gel, Pulsed-Field; D005602:France / Q000453:epidemiology; D017353:Gene Deletion; D005798:Genes, Bacterial; D019450:Genes, MDR; D005839:Gentamicins / Q000494:pharmacology; D006801:Humans; D016106:Methicillin Resistance / Q000235:genetics; D010641:Phenotype; D013203:Staphylococcal Infections / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology; D013211:Staphylococcus aureus / Q000187:drug effects* / Q000235:genetics / Q000302:isolation & purification*; D013997:Time Factors; D014900:West Indies / Q000453:epidemiology
chemical_list: D005839:Gentamicins