Long-term persistence of a multi-resistant methicillin-susceptible Staphylococcus aureus (MR-MSSA) clone at a university hospital in southeast Sweden, without further transmission within the region
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The objective of this study was to characterise isolates of methicillin-susceptible Staphylococcus aureus (MSSA) with resistance to clindamycin and/or tobramycin in southeast Sweden, including the previously described ECT-R clone (t002) found in Östergötland County, focusing on clonal relatedness, virulence determinants and existence of staphylococcal cassette chromosome (SCC) mec remnants. MSSA isolates with resistance to clindamycin and/or tobramycin were collected from the three county councils in southeast Sweden and investigated with spa typing, polymerase chain reaction (PCR) targeting the SCCmec right extremity junction (MREJ) and DNA microarray technology. The 98 isolates were divided into 40 spa types, and by microarray clustered in 17 multi-locus sequence typing (MLST) clonal complexes (MLST-CCs). All isolates with combined resistance to clindamycin and tobramycin (n = 12) from Östergötland County and two additional isolates (clindamycin-R) were designated as spa type t002, MREJ type ii and were clustered in CC5, together with a representative isolate of the ECT-R clone, indicating the clone’s persistence. These isolates also carried several genes encoding exotoxins, Q9XB68-dcs and qacC. Of the isolates in CC15, 83 % (25/30) were tobramycin-resistant and were designated spa type t084. Of these, 68 % (17/25) were isolated from new-borns in all three counties. The persistence of the ECT-R clone in Östergötland County, although not found in any other county in the region, carrying certain virulence factors that possibly enhance its survival in the hospital environment, highlights the fact that basic hygiene guidelines must be maintained even when MRSA prevalence is low.
KeywordsClindamycin Tobramycin Moxifloxacin County Council SCCmec Type
We are grateful for all the help from the people in the participating clinical microbiology laboratories, and especially Annika Wistedt, Kalmar County Hospital and Lennart E. Nilsson and Anita Johansson, Linköping University and Linköping University Hospital. This study was financially supported by the Östergötland County Council, Sweden, the Medical Research Council of Southeast Sweden (FORSS) and the Scandinavian Society for Antimicrobial Chemotherapy (SSAC)
Conflict of interest
The authors have no conflicts of interest to be declared.
This study was approved by the Regional Ethical Review Board in Linköping, Sweden (M164-09), who judged that there was no need for informed consent to be obtained is this study.
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