title: Molecular epidemiology of community-associated methicillin-resistant Staphylococcus aureus in Spain: 2004-12.
abstract: OBJECTIVE
  In Spain, despite the high rates of healthcare-associated methicillin-resistant Staphylococcus aureus (MRSA), the incidence of community-associated (CA) MRSA seems to be low on the basis of a small number of studies. We analysed the evolution of CA-MRSA in Spain from 2004 to 2012, and identified the clonal lineages and population structure.
  
  
  METHODS
  The study included 8326 MRSA strains. Susceptibility to 18 antimicrobials was determined. Isolates were tested for the presence of mecA, Panton-Valentine leucocidin (PVL) and the arginine catabolic mobile element (ACME) by PCR, and typed by staphylococcal cassette chromosome mec, PFGE, spa, multilocus sequence typing and agr.
  
  
  RESULTS
  Among the 8326 isolates, 246 (2.9%) were CA-MRSA. We identified genotypically 226 PVL-positive CA-MRSA isolates (88% agr type I, 10.2% agr type III and 1.8% agr type II) and 20 PVL-negative CA-MRSA isolates (all agr type I) from children and adults (82.1% from wounds) from 13 different geographical areas. A significant increase in the rates of CA-MRSA was observed when comparing 2004-07 (0.43%) with 2008-12 (5.44%). Resistance rates were as follows: only β-lactams, 84.5%; erythromycin, 12.8%; tetracycline, 8.8%; clindamycin, 4.9%; ciprofloxacin, 3.1%; fusidic acid, 2.0%; others, 0.4%; and multiresistant, 6.2% (six isolates USA300). The strains belonged to the PVL-positive clones ST8-IVc (69.9%), ST8-IVa-ACME-positive (USA300, 8.9%), ST8-IVa-ACME-negative (0.8%), ST30-IVc (4.5%), ST80-IVc (2.0%), ST5-IVc (1.2%) and others (ST59, ST72, ST88, ST642, ST1472 and ST1829; 4.5%) and to the PVL-negative ST398-V (8.1%).
  
  
  CONCLUSIONS
  We confirm an increase in CA-MRSA in Spain, the predominance of the ST8-IVc clone, the emergence of the USA300 clone, a high genetic diversity among PVL-positive CA-MRSA isolates and the recent emergence of the pig-associated ST398-V clone.
authors.affiliation: Servicio de Microbiología, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Spain.
authors.forename: Ana
authors.initials: A
authors.lastname: Vindel
authors.affiliation: Servicio de Microbiología, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Spain.
authors.forename: Pilar
authors.initials: P
authors.lastname: Trincado
authors.affiliation: Servicio de Microbiología, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Spain.
authors.forename: Oscar
authors.initials: O
authors.lastname: Cuevas
authors.affiliation: Servicio de Microbiología, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Spain.
authors.forename: Carmen
authors.initials: C
authors.lastname: Ballesteros
authors.affiliation: Servicio de Microbiología y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, Madrid, Spain Department of Medicine, Facultad de Medicina, Universidad Complutense, Madrid, Spain.
authors.forename: Emilio
authors.initials: E
authors.lastname: Bouza
authors.affiliation: Servicio de Microbiología y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, Madrid, Spain Department of Medicine, Facultad de Medicina, Universidad Complutense, Madrid, Spain emilia.cercenado@salud.madrid.org.
authors.forename: Emilia
authors.initials: E
authors.lastname: Cercenado
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D017714:Community-Acquired Infections / Q000175:diagnosis / Q000453:epidemiology / Q000235:genetics; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008712:Methicillin / Q000494:pharmacology / Q000627:therapeutic use*; D055624:Methicillin-Resistant Staphylococcus aureus / Q000187:drug effects / Q000235:genetics* / Q000302:isolation & purification*; D008875:Middle Aged; D017720:Molecular Epidemiology; D013030:Spain / Q000453:epidemiology; D013203:Staphylococcal Infections / Q000175:diagnosis / Q000453:epidemiology* / Q000235:genetics*; D055815:Young Adult
chemical_list: D008712:Methicillin
keywords: MRSA; PVL; ST398; community-associated MRSA; linezolid; livestock-associated MRSA; skin and soft-tissue infections