title: Methicillin-resistant Staphylococcus aureus carrying the mecC gene: emergence in Spain and report of a fatal case of bacteraemia.
abstract: OBJECTIVE
  Methicillin-resistant Staphylococcus aureus (MRSA) strains carrying the mecC gene have been reported from humans and animals from several European countries, but never from Spain. We describe the first isolates of mecC-positive MRSA of human origin collected in Spain and report a fatal case of bacteraemia.
  
  
  METHODS
  Isolates were tested for phenotypic resistance using cefoxitin, tested for the mecA/mecC genes and toxin genes by PCR, and typed by staphylococcal cassette chromosome mec (SCCmec), PFGE, spa, multilocus sequence typing and agr.
  
  
  RESULTS
  During 2008-13 five MRSA isolates showing resistance to cefoxitin and carrying the mecC gene were recovered at one hospital in Spain. In a review of 5505 S. aureus strains received at the Spanish National Reference Centre for Staphylococci from the same period, we found two additional mecC-positive isolates. The isolates were recovered from blood (two), wounds (two), joint fluid (one), urine (one) and a nasal swab (one). All MRSA were mecA negative, presented SCCmecXI, belonged to agr group III and to clonal complex 130, and were negative for the production of the toxin genes tst1, eta, etb, etd and Panton-Valentine leucocidin. Six isolates belonged to spa type t843 (ST130 and ST1945, where ST stands for sequence type) and one to spa type t6220 (ST1945). One patient with mecC-positive MRSA sepsis died in the emergency department.
  
  
  CONCLUSIONS
  We confirm the presence of MRSA carrying the mecC gene in Spain, the ability of this livestock-associated MRSA to cause severe infections in humans and the need to perform culture-based susceptibility testing methods in order to detect these emerging strains.
authors: Servicio de Microbiología, Hospital Lucus Augusti, Lugo, Spain.
authors: Fernando
authors: F
authors: García-Garrote
authors: Emilia
authors: E
authors: Cercenado
authors: Mercedes
authors: M
authors: Marín
authors: Mercedes
authors: M
authors: Bal
authors: Pilar
authors: P
authors: Trincado
authors: Juan
authors: J
authors: Corredoira
authors: Carmen
authors: C
authors: Ballesteros
authors: Julia
authors: J
authors: Pita
authors: Pilar
authors: P
authors: Alonso
authors: Ana
authors: A
authors: Vindel
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000818:Animals; D000900:Anti-Bacterial Agents / Q000494:pharmacology; D016470:Bacteremia / Q000382:microbiology*; D001426:Bacterial Proteins / Q000235:genetics*; D002440:Cefoxitin / Q000494:pharmacology; D002675:Child, Preschool; D004269:DNA, Bacterial / Q000235:genetics; D017809:Fatal Outcome; D005260:Female; D005838:Genotype; D006801:Humans; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus / Q000145:classification / Q000187:drug effects / Q000235:genetics* / Q000302:isolation & purification*; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D058889:Molecular Typing; D016133:Polymerase Chain Reaction; D013030:Spain; D013203:Staphylococcal Infections / Q000382:microbiology*; D037521:Virulence Factors / Q000235:genetics
chemical_list: D000900:Anti-Bacterial Agents; D001426:Bacterial Proteins; D004269:DNA, Bacterial; D037521:Virulence Factors; D002440:Cefoxitin
keywords: community-associated MRSA; livestock-associated MRSA; skin and soft-tissue infections