title: Fusidic acid resistance among clinical isolates of methicillin-resistant Staphylococcus aureus in a Taiwanese hospital.
abstract: BACKGROUND
  The prevalence of resistance to fusidic acid of methicillin-resistant Staphylococcus aureus (MRSA) was increased each year in a Taiwan hospital. Thirty-four MRSA clinical isolates collected in 2007 and 2008 with reduced susceptibility to FA were selected for further evaluation the presence of resistance determinants.
  
  
  RESULTS
  The most common resistance determinant was fusC, found in 25 of the 34 MRSA isolates. One of the 25 fusidic acid-resistant MRSA harboured both fusB and fusC, which is the first time this has been identified. Mutations in fusA were found in 10 strains, a total of 3 amino-acid substitutions in EF-G (fusA gene) were detected. Two substitutions with G556S and R659L were identified for the first time. Low-level resistance to fusidic acid (MICs, ≤32 μg/ml) was found in most our collection. All collected isolates carried type III SCCmec elements. MLST showed the isolates were MRSA ST239. PFGE revealed nine different pulsotypes in one cluster.
  
  
  CONCLUSIONS
  Our results indicate that the increase in the number of fusidic acid resistant among the MRSA isolates in this hospital is due mainly to the distribution of fusC determinants. Moreover, more than one fusidic acid-resistance mechanism was first detected in a same stain in our collection.
authors.affiliation: Department of Internal Medicine, Tungs' Taichung MetroHarbor Hospital, and Department of Microbiology, China Medical University, Taichung, Taiwan.
authors.forename: Chih-Ming
authors.initials: CM
authors.lastname: Chen
authors.forename: Mei
authors.initials: M
authors.lastname: Huang
authors.forename: Huei-Fen
authors.initials: HF
authors.lastname: Chen
authors.forename: Se-Chin
authors.initials: SC
authors.lastname: Ke
authors.forename: Chia-Ru
authors.initials: CR
authors.lastname: Li
authors.forename: Jen-Hsien
authors.initials: JH
authors.lastname: Wang
authors.forename: Lii-Tzu
authors.initials: LT
authors.lastname: Wu
mesh_terms: D019943:Amino Acid Substitution / Q000235:genetics; D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D001426:Bacterial Proteins / Q000235:genetics; D004269:DNA, Bacterial / Q000235:genetics; D024881:Drug Resistance, Bacterial; D005672:Fusidic Acid / Q000494:pharmacology*; D006761:Hospitals; D006801:Humans; D055624:Methicillin-Resistant Staphylococcus aureus / Q000187:drug effects* / Q000235:genetics* / Q000302:isolation & purification; D008826:Microbial Sensitivity Tests; D020125:Mutation, Missense; D020653:Peptide Elongation Factor G / Q000235:genetics; D013203:Staphylococcal Infections / Q000382:microbiology*; D013624:Taiwan
chemical_list: D000900:Anti-Bacterial Agents; D001426:Bacterial Proteins; D004269:DNA, Bacterial; C492444:FusA protein, Staphylococcus aureus; C492443:FusB protein, Staphylococcus aureus; D020653:Peptide Elongation Factor G; D005672:Fusidic Acid