title: ST9 MRSA strains carrying a variant of type IX SCCmec identified in the Thai community.
abstract: BACKGROUND
  Infections caused by methicillin-resistant Staphylococcus aureus (MRSA) in Thailand occur most frequently in healthcare facilities. However, reports of community-associated MRSA are limited.
  
  
  METHODS
  We characterized 14 MRSA isolates from outpatients (O-1 to O-14) by phenotypic and genotypic methods and compared them with 5 isolates from inpatients (I-1 to I-5). Thai MRSA isolates from a healthcare worker (N-1) and a pig (P-1) were also included as ST9 MRSA strains from other sources.
  
  
  RESULTS
  All MRSA isolates from the outpatients and inpatients were multidrug-resistant (resistant to ≥3 classes of antimicrobials). All of them except strains O-2 and I-3 carried type III SCCmec and belonged to agrI, coagulase IV, spa type t037 or t233, which related to ST239. The strain O-2 (JCSC6690) carried type IX SCCmec and belonged to agrII, coagulaseXIc, spa type t337 and ST9, whereas the strain I-3 carried a type III SCCmec and belonged to ST1429. Nucleotide sequence determination revealed that the type IX SCCmec element in strain O-2 was distinct from that in a Thai ST398 strain (JCSC6943) previously identified in 2011; nucleotide identities of ccrA and ccrB were 93 and 91%, respectively and several open reading frames (ORFs) at the joining regions were different. PCR experiments suggested that strain O-2 and N-1 carried similar SCCmec element, whereas that of strain P-1 was different, suggesting that distinct ST9-MRSA-IX clones might be spreading in this province.
  
  
  CONCLUSIONS
  The SCCmecIX-ST9 MRSA clones of distinct SCCmec subtypes might have emerged in the Thai community and might also have disseminated into the hospital.
authors.affiliation: Centre for Research and Development of Medical Diagnostic Laboratories, Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen, Thailand.
authors.forename: Aroonlug
authors.initials: A
authors.lastname: Lulitanond
authors.forename: Teruyo
authors.initials: T
authors.lastname: Ito
authors.forename: Shanshuang
authors.initials: S
authors.lastname: Li
authors.forename: Xiao
authors.initials: X
authors.lastname: Han
authors.forename: Xiao Xue
authors.initials: XX
authors.lastname: Ma
authors.forename: Chulapan
authors.initials: C
authors.lastname: Engchanil
authors.forename: Aroonwadee
authors.initials: A
authors.lastname: Chanawong
authors.forename: Chotechana
authors.initials: C
authors.lastname: Wilailuckana
authors.forename: Netchanok
authors.initials: N
authors.lastname: Jiwakanon
authors.forename: Keiichi
authors.initials: K
authors.lastname: Hiramatsu
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology; D016521:Electrophoresis, Gel, Pulsed-Field; D005798:Genes, Bacterial; D006801:Humans; D016106:Methicillin Resistance; D055624:Methicillin-Resistant Staphylococcus aureus / Q000187:drug effects* / Q000235:genetics / Q000302:isolation & purification*; D008826:Microbial Sensitivity Tests; D058889:Molecular Typing; D013203:Staphylococcal Infections / Q000382:microbiology*; D013785:Thailand
chemical_list: D000900:Anti-Bacterial Agents