title: Population dynamics of methicillin-susceptible and -resistant Staphylococcus aureus in remote communities.
abstract: OBJECTIVE
  Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) was first reported in remote regions of Western Australia (WA) in 1992 and is now the predominant MRSA isolated in the State. To gain insights into the emergence of CA-MRSA, 2146 people living in 11 remote WA communities were screened for colonization with S. aureus.
  
  
  METHODS
  Antibiogram analysis, contour-clamped homogeneous electric field electrophoresis, multilocus sequence typing, Panton-Valentine leucocidin determinant detection and accessory genetic regulator typing were performed to characterize the isolates. MRSA was further characterized by staphylococcal cassette chromosome mec typing.
  
  
  RESULTS
  The S. aureus population consisted of 13 clonal complexes and two Singleton lineages together with 56 sporadic isolates. Five lineages contained MRSA; however, these were not the predominant methicillin-susceptible S. aureus (MSSA) lineages. There was greater diversity amongst the MSSA while the MRSA appeared to have emerged clonally following acquisition of the staphylococcal cassette chromosome mec. Three MRSA lineages were considered to have been endemic in the communities and have subsequently become predominant lineages of CA-MRSA in the wider WA community. People colonized with MSSA tended to harbour clones of a different genetic lineage at each anatomical site while people colonized with MRSA tended to harbour clones of the same lineage at each site. Overall, the isolates were resistant to few antimicrobials.
  
  
  CONCLUSIONS
  Although the evidence suggests that in WA CA-MRSA strains arose in remote communities and have now disseminated into the wider community, there is no evidence that they arose from the predominant MSSA clones in these communities.
authors.affiliation: Gram-positive Bacteria Typing and Research Unit, Curtin University of Technology, School of Biomedical Sciences, Perth, Western Australia. f.g.obrien@curtin.edu.au
authors.forename: F G
authors.initials: FG
authors.lastname: O'Brien
authors.forename: G W
authors.initials: GW
authors.lastname: Coombs
authors.forename: J W
authors.initials: JW
authors.lastname: Pearman
authors.forename: M
authors.initials: M
authors.lastname: Gracey
authors.forename: F
authors.initials: F
authors.lastname: Moss
authors.forename: K J
authors.initials: KJ
authors.lastname: Christiansen
authors.forename: W B
authors.initials: WB
authors.lastname: Grubb
mesh_terms: D001426:Bacterial Proteins / Q000235:genetics; D001427:Bacterial Toxins / Q000235:genetics; D015373:Bacterial Typing Techniques; D002353:Carrier State / Q000382:microbiology*; D016000:Cluster Analysis; D017714:Community-Acquired Infections / Q000382:microbiology*; D016172:DNA Fingerprinting; D004269:DNA, Bacterial / Q000235:genetics; D016521:Electrophoresis, Gel, Pulsed-Field; D005098:Exotoxins / Q000235:genetics; D006801:Humans; D007956:Leukocidins / Q000235:genetics; D055624:Methicillin-Resistant Staphylococcus aureus / Q000145:classification* / Q000187:drug effects* / Q000302:isolation & purification; D008826:Microbial Sensitivity Tests; D017720:Molecular Epidemiology; D016133:Polymerase Chain Reaction; D012424:Rural Population; D017422:Sequence Analysis, DNA; D013203:Staphylococcal Infections / Q000382:microbiology*; D015534:Trans-Activators / Q000235:genetics; D014904:Western Australia
chemical_list: C095698:Agr protein, Staphylococcus aureus; D001426:Bacterial Proteins; D001427:Bacterial Toxins; D004269:DNA, Bacterial; D005098:Exotoxins; D007956:Leukocidins; C078284:Panton-Valentine leukocidin; D015534:Trans-Activators