title: mecA-positive Staphylococcus aureus with low-level oxacillin MIC in Taiwan.
abstract: Although the presence of mecA is the genotypic determinant of methicillin-resistant Staphylococcus aureus (MRSA), certain MRSA strains, especially community-associated MRSA (C-MRSA), can display an oxacillin MIC in the Clinical and Laboratory Standards Institute susceptible breakpoint range (≤ 2 μg/ml). Among 91 and 180 isolates thought to be methicillin-susceptible S. aureus (MSSA) with oxacillin MICs of 2 and 1 μg/ml as determined by the Sensititre broth microdilution test initially, 52 (57.1%) and 6 (3.3%), respectively, were mecA positive. These mecA-positive low-oxacillin-MIC isolates belong to the dominant Taiwan C-MRSA clone (clonal complex [CC] 59), 56 of which carried SCCmec type V and were pvl positive, and 43 of which belonged to spa CC t437. All 271 isolates were retested by Sensititre, as well as by Vitek II and disk diffusion (DD). Based on the oxacillin results, the sensitivities of the Sensititre, Vitek II, and DD methods were 48.3% (28/58), 46.6% (27/58), and 89.6% (52/58), respectively. Although cefoxitin was better at detecting these isolates, 12.1, 10.4, and 5.2% of these isolates were still misidentified as MSSA by Sensititre, Vitek II, and DD, respectively. These results highlight the difficulty in the accurate identification of MRSA with borderline oxacillin MICs in the CC59:SCCmec V clone, which likely has contributed to its spread in the health care and community settings. Since this clone has now been detected in other countries, and since other C-MRSA lineages have also been found to have low-level β-lactam resistance, the findings of the present study may be relevant to other regions. Further studies are warranted to determine the extent and clinical impact of such misidentification.
authors.affiliation: Division of Infectious Diseases, National Institute of Infectious Diseases and Vaccinology, National Health Research Institutes, Zhunan, Taiwan.
authors.forename: Feng-Jui
authors.initials: FJ
authors.lastname: Chen
authors.forename: I-Wen
authors.initials: IW
authors.lastname: Huang
authors.forename: Chen-Her
authors.initials: CH
authors.lastname: Wang
authors.forename: Pei-Chen
authors.initials: PC
authors.lastname: Chen
authors.forename: Hui-Yin
authors.initials: HY
authors.lastname: Wang
authors.forename: Jui-Fen
authors.initials: JF
authors.lastname: Lai
authors.forename: Yih-Ru
authors.initials: YR
authors.lastname: Shiau
authors.forename: Tsai-Ling Yang
authors.initials: TL
authors.lastname: Lauderdale
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D001426:Bacterial Proteins / Q000235:genetics*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005838:Genotype; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus / Q000187:drug effects* / Q000235:genetics* / Q000302:isolation & purification; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D058889:Molecular Typing; D010068:Oxacillin / Q000494:pharmacology*; D046915:Penicillin-Binding Proteins; D013203:Staphylococcal Infections / Q000382:microbiology*; D013624:Taiwan; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D001426:Bacterial Proteins; D046915:Penicillin-Binding Proteins; C487789:mecA protein, Staphylococcus aureus; D010068:Oxacillin