title: MRSA genotypes in Turkey: persistence over 10 years of a single clone of ST239.
abstract: OBJECTIVE
  Methicillin-resistant Staphylococcus aureus (MRSA) is a significant cause of life-threatening human infections. The clinical impact of MRSA is mounting, not only due to the ever-increasing prevalence but also due to the occurrence of new, community-acquired MRSA strains. The aim of this prospective, multi-centre study was to determine the prevalence and genetic relatedness of clinically relevant MRSA isolates, in Turkey.
  
  
  METHODS
  During a 1-year period, data from 20 successive patients with invasive S. aureus infections were collected from eight university hospitals, geographically distributed over the six main regions of Turkey. Among these S. aureus isolates, the genetic association of MRSA isolates was investigated by pulsed-field gel electrophoresis (PFGE) and spa typing. A selected number of isolates were also analyzed by multilocus sequence typing (MLST). Furthermore, Panton Valentine leucocidin (PVL) genes were examined.
  
  
  RESULTS
  In this study, the rate of methicillin resistance in S. aureus in patients with apparent infections (sepsis, meningitis, lung abscess or septic arthritis) ranged from 12 to 75% within the seven participating centres. Typing by pulsed-field gel electrophoresis and spa typing revealed the presence of 22 closely related genotypes. According to the PFGE and spa typing results, 53 out of 54 MRSA isolates were closely related. These isolates were of spa type t030 or a related spa type, contain an SCC mec type III element and belong to sequence type ST239. None of the isolates contained the PVL genes.
  
  
  CONCLUSIONS
  Despite the broad surface area of Turkey, a single predominant clone of ST239 circulates in hospitals in different regions and only few new types of MRSA were introduced over the past years. These results place Turkey in the epicenter of ST239 prevalence.
authors.affiliation: Erciyes University, Department of Infectious Diseases and Clinical Microbiology, Kayseri 38039, Turkey. ealp@erciyes.edu.tr
authors.forename: Emine
authors.initials: E
authors.lastname: Alp
authors.forename: Corné H W
authors.initials: CH
authors.lastname: Klaassen
authors.forename: Mehmet
authors.initials: M
authors.lastname: Doganay
authors.forename: Ulku
authors.initials: U
authors.lastname: Altoparlak
authors.forename: Kemalettin
authors.initials: K
authors.lastname: Aydin
authors.forename: Aynur
authors.initials: A
authors.lastname: Engin
authors.forename: Cigdem
authors.initials: C
authors.lastname: Kuzucu
authors.forename: Cuneyt
authors.initials: C
authors.lastname: Ozakin
authors.forename: Mehmet Ali
authors.initials: MA
authors.lastname: Ozinel
authors.forename: Ozge
authors.initials: O
authors.lastname: Turhan
authors.forename: Andreas
authors.initials: A
authors.lastname: Voss
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001426:Bacterial Proteins / Q000235:genetics; D001427:Bacterial Toxins / Q000235:genetics*; D002648:Child; D002675:Child, Preschool; D017714:Community-Acquired Infections; D003428:Cross Infection; D004198:Disease Susceptibility; D016521:Electrophoresis, Gel, Pulsed-Field; D005098:Exotoxins / Q000235:genetics*; D005260:Female; D005838:Genotype; D006801:Humans; D007223:Infant; D007956:Leukocidins / Q000235:genetics*; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus / Q000235:genetics*; D008875:Middle Aged; D046915:Penicillin-Binding Proteins; D015995:Prevalence; D011446:Prospective Studies; D013203:Staphylococcal Infections / Q000453:epidemiology* / Q000382:microbiology* / Q000635:transmission; D014421:Turkey / Q000453:epidemiology; D055815:Young Adult
chemical_list: D001426:Bacterial Proteins; D001427:Bacterial Toxins; D005098:Exotoxins; D007956:Leukocidins; C078284:Panton-Valentine leukocidin; D046915:Penicillin-Binding Proteins; C487789:mecA protein, Staphylococcus aureus