title: Dissemination of nosocomial multiple-aminoglycoside-resistant Staphylococcus aureus caused by horizontal transfer of the resistance determinant (aacA/aphD) and clonal spread of resistant strains.
abstract: BACKGROUND
  The multiple-aminoglycoside-resistant gene aacA/aphD exists as a transposable genetic element (Tn4001) in gram-positive cocci. Here we describe our retrospective investigation of the mechanism responsible for the dissemination of Tn4001 among staphylococci present in clinical isolates collected in our university hospital. At its peak, about 80% of the total isolates of methicillin-resistant Staphylococcus aureus showed multiple-aminoglycoside resistance, and all harbored aacA/aphD.
  
  
  METHODS
  Clonal relatedness was analyzed by pulsed field gel electrophoresis after SmaI endonuclease digestion of the genomic DNA from isolates collected in 1991 and 1997. To detect Tn4001 on the chromosome and conjugative plasmids, specific sequences from aacA/aphD and the insertion sequence IS256, whose inverted sequence flanks aacA/aphD, were amplified by polymerase chain reaction.
  
  
  RESULTS
  Pulsed field gel electrophoresis of genomic DNA, plasmid analysis, and polymerase chain reaction detection of the resistance determinant all indicated the presence of disseminated clones that had survived among hospitalized patients through acquisition of conjugative plasmids harboring aacA/aphD. Furthermore, aacA/aphD also disseminated among nosocomial strains other than S aureus as a consequence of the self-transferability of Tn4001.
  
  
  CONCLUSIONS
  The nosocomial prevalence of multiple-aminoglycoside-resistant staphylococci is the result of both horizontal and interspecific transfer of aacA/aphD and the clonal spread and survival of resistant strains.
authors.affiliation: Department of Clinical Microbiology, School of Health Sciences, University of Occupational and Environmental Health, Kitakyushu, Japan.
authors.forename: Takezo
authors.initials: T
authors.lastname: Udou
mesh_terms: D000595:Amino Acid Sequence; D000617:Aminoglycosides / Q000235:genetics / Q000494:pharmacology*; D000900:Anti-Bacterial Agents / Q000494:pharmacology; D004269:DNA, Bacterial; D018562:Disease Transmission, Infectious; D024901:Drug Resistance, Multiple, Bacterial / Q000235:genetics*; D005260:Female; D005798:Genes, Bacterial / Q000187:drug effects; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D010597:Pharmacogenetics; D010957:Plasmids / Q000235:genetics; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D013203:Staphylococcal Infections / Q000175:diagnosis / Q000635:transmission*; D013211:Staphylococcus aureus / Q000187:drug effects* / Q000235:genetics* / Q000302:isolation & purification
chemical_list: D000617:Aminoglycosides; D000900:Anti-Bacterial Agents; D004269:DNA, Bacterial