title: Dissemination of methicillin-resistant Staphylococcus aureus SCCmec type IV and SCCmec type V epidemic clones in a tertiary hospital: challenge to infection control.
abstract: Two-hundred MRSA strains from inpatients with healthcare-associated (HA) and 100 MRSA strains from outpatients with community-associated (CA) skin and soft tissue infections (SSTIs) were tested for antimicrobial susceptibility, staphylococcal cassette chromosome mec (SCCmec) typing, Panton-Valentine leucocidin (PVL) toxin, seh and arcA genes. Based on SCCmec typing, HA-MRSA isolates were further divided into HA-SCCmec I/II/III MRSA and HA-SCCmec IV/V MRSA, and CA-MRSA isolates into CA-SCCmec I/II/III MRSA and CA-SCCmec IV/V MRSA. SCCmec types were further characterized by pulsed-field gel electrophoresis, spa typing and multi-locus sequence typing. Seventy-five (37·5%) HA-MRSA isolates and 83/100 CA-MRSA isolates were SCCmec IV/V genotype. HA-SCCmec IV/V MRSA was associated with malignancy (P = 0·03) and bone fractures (P = 0·02) compared to CA-SCCmec IV/V MRSA. HA-SCCmec IV/V MRSA was associated with PVL gene carriage compared to HA-SCCmec I/II/III MRSA (P < 0·001). ST22-MRSA-IV (EMRSA-15), ST772-MRSA-V, and ST36-MRSA-IV and ST239:EMRSA-I:III were the major clones identified. Our study documents the emergence of SCCmec IV and SCCmec V MRSA clones in an Indian hospital.
authors.affiliation: Department of Microbiology,AIIMS,New Delhi,India.
authors.forename: B
authors.initials: B
authors.lastname: Dhawan
authors.affiliation: Department of Microbiology,AIIMS,New Delhi,India.
authors.forename: C
authors.initials: C
authors.lastname: Rao
authors.affiliation: Department of Microbiology, Faculty of Medicine,Kuwait University,Safat,Kuwait.
authors.forename: E E
authors.initials: EE
authors.lastname: Udo
authors.affiliation: Department of Microbiology,AIIMS,Jodhpur,India.
authors.forename: R
authors.initials: R
authors.lastname: Gadepalli
authors.affiliation: Department of Biostatistics,AIIMS,New Delhi,India.
authors.forename: S
authors.initials: S
authors.lastname: Vishnubhatla
authors.affiliation: Department of Microbiology,AIIMS,New Delhi,India.
authors.forename: A
authors.initials: A
authors.lastname: Kapil
mesh_terms: D000293:Adolescent; D000328:Adult; D000900:Anti-Bacterial Agents / Q000494:pharmacology; D001426:Bacterial Proteins / Q000235:genetics; D001427:Bacterial Toxins / Q000235:genetics; D002648:Child; D003428:Cross Infection / Q000453:epidemiology / Q000382:microbiology* / Q000517:prevention & control*; D004768:Enterotoxins / Q000235:genetics; D005098:Exotoxins / Q000235:genetics; D005260:Female; D006801:Humans; D017053:Infection Control; D007956:Leukocidins / Q000235:genetics; D008297:Male; D016106:Methicillin Resistance / Q000235:genetics; D055624:Methicillin-Resistant Staphylococcus aureus / Q000145:classification / Q000187:drug effects / Q000235:genetics / Q000302:isolation & purification; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D058885:Multilocus Sequence Typing; D013203:Staphylococcal Infections / Q000453:epidemiology / Q000382:microbiology* / Q000517:prevention & control*; D062606:Tertiary Care Centers / Q000706:statistics & numerical data*; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D001426:Bacterial Proteins; D001427:Bacterial Toxins; D004768:Enterotoxins; D005098:Exotoxins; D007956:Leukocidins; C078284:Panton-Valentine leukocidin; C402489:Staphylococcal enterotoxin H