title: Polyclonal emergence and importation of community-acquired methicillin-resistant Staphylococcus aureus strains harbouring Panton-Valentine leucocidin genes in Belgium.
abstract: OBJECTIVE
  Worldwide spread of a limited number of Panton-Valentine leucocidin (PVL) -producing methicillin-resistant Staphylococcus aureus (MRSA) clones has been reported in various communities. The objective of this study was to describe the molecular characteristics of the first PVL-positive MRSA strains isolated in Belgium.
  
  
  METHODS
  Clinical MRSA isolates (n = 41) collected from 2002 to 2004 from Belgian patients were investigated for the PVL gene by PCR. PVL-positive isolates were genotyped by PFGE, staphylococcal cassette chromosome mec (SCCmec) typing, spa sequence typing, accessory gene regulator (agr) polymorphism and multi-locus sequence typing (MLST). Susceptibility to 14 antimicrobials was determined by the disc diffusion method. Genes encoding resistance to tetracyclines, aminoglycosides and macrolide-lincosamide-streptogramin were determined by PCR.
  
  
  RESULTS
  Sixteen isolates carried lukS-lukF genes that encode the PVL toxin. All but one isolate were community-acquired. Three patients reported recent travel to North Africa and South America. They were associated with skin or soft tissue infections, bacteraemia and peritonitis. By molecular typing, they belonged to five genotypes: ST80-SCCmec IV, ST8-SCCmec IV, ST30-SCCmec IV, ST153-SCCmec IV and ST88-SCCmec IV. They belonged to the agr type 3 except for ST8 strains, which showed agr type 1. All isolates were susceptible to fluoroquinolones. Approximately, half of them were resistant to tetracycline, fusidic acid and kanamycin. Tetracycline-resistant strains harboured the tet(K) gene and resistance to kanamycin was associated with the aph3'-IIIa gene. The single erythromycin-resistant isolate harboured msr(A/B) genes conferring the M resistance phenotype.
  
  
  CONCLUSIONS
  These results indicate the recent emergence and sporadic importation into Belgium of PVL-positive community-associated MRSA strains belonging to five distinct clones.
authors.affiliation: Laboratoire de Référence MRSA--Staphylocoques, Department of Microbiology, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium. odenis@ulb.ac.be
authors.forename: O
authors.initials: O
authors.lastname: Denis
authors.forename: A
authors.initials: A
authors.lastname: Deplano
authors.forename: H
authors.initials: H
authors.lastname: De Beenhouwer
authors.forename: M
authors.initials: M
authors.lastname: Hallin
authors.forename: G
authors.initials: G
authors.lastname: Huysmans
authors.forename: M G
authors.initials: MG
authors.lastname: Garrino
authors.forename: Y
authors.initials: Y
authors.lastname: Glupczynski
authors.forename: X
authors.initials: X
authors.lastname: Malaviolle
authors.forename: A
authors.initials: A
authors.lastname: Vergison
authors.forename: M J
authors.initials: MJ
authors.lastname: Struelens
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000494:pharmacology; D001426:Bacterial Proteins / Q000235:genetics; D001427:Bacterial Toxins / Q000235:genetics*; D001530:Belgium; D002648:Child; D002675:Child, Preschool; D017714:Community-Acquired Infections / Q000382:microbiology / Q000635:transmission; D004269:DNA, Bacterial / Q000737:chemistry / Q000235:genetics; D024881:Drug Resistance, Bacterial / Q000235:genetics; D005098:Exotoxins / Q000235:genetics*; D005260:Female; D006801:Humans; D007223:Infant; D007956:Leukocidins / Q000235:genetics*; D008297:Male; D016106:Methicillin Resistance; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D017720:Molecular Epidemiology; D012150:Polymorphism, Restriction Fragment Length; D013203:Staphylococcal Infections / Q000382:microbiology* / Q000635:transmission; D013211:Staphylococcus aureus / Q000187:drug effects / Q000235:genetics* / Q000302:isolation & purification; D037521:Virulence Factors / Q000235:genetics
chemical_list: D000900:Anti-Bacterial Agents; D001426:Bacterial Proteins; D001427:Bacterial Toxins; D004269:DNA, Bacterial; D005098:Exotoxins; D007956:Leukocidins; C078284:Panton-Valentine leukocidin; D037521:Virulence Factors