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Journal of Clinical Microbiology, January 1998, p. 81-85, Vol. 36, No. 1
0095-1137/98/$04.00+0
Copyright © 1998, American Society for Microbiology. All rights reserved.

Characterization of Gentamicin-Susceptible Strains of Methicillin-Resistant Staphylococcus aureus Involved in Nosocomial Spread

Nadine Lemaître,1,* Wladimir Sougakoff,1 Afef Masmoudi,1,2 Marie-Hélène Fievet,3 Roland Bismuth,1 and Vincent Jarlier1

Laboratoire de Bactériologie-Hygiène1 and Pharmacie,3 Groupe Hospitalier Pitié-Salpêtrière, Paris, France, and Laboratoire de Bactériologie, Centre Hospitalier-Universitaire La Rabta, Tunis, Tunisia2

Received 26 June 1997/Returned for modification 4 August 1997/Accepted 10 October 1997

We report an outbreak of epidemic Staphylococcus aureus strains characterized by an unusual heterogeneous resistance to methicillin and resistance to tobramycin but susceptibility to gentamicin (gentamicin-susceptible methicillin-resistant S. aureus [GS-MRSA]), contrasting with gentamicin-resistant homogeneous MRSA (GR-MRSA) that have been endemic in our hospital since the 1970s. A total of 97 GS-MRSA strains, which were shown by DNA hybridization to carry the mecA and ant(4')-Ia genes, were studied. The 40 GS-MRSA strains isolated at the beginning of the outbreak (January 1992 to June 1993) were typed by using resistance patterns, phage typing, serotyping, and pulsed-field gel electrophoresis and were compared with GR-MRSA and methicillin-susceptible S. aureus (MSSA) strains isolated during the same period. Two dominant clones, A::1 and B::3, and one minor clone, C::5, were identified among the 40 GS-MRSA strains, according to pulsotypes (A to C) and their resistance patterns (1, 3, and 5), which were distinguishable from those of GR-MRSA and MSSA strains. A selection of 57 GS-MRSA strains, isolated from 1994 to 1996, were clustered in the same three clones. However, their distribution had changed in comparison with that in the 1992 to 1993 period: clone A::1 remained dominant (47 versus 42.5%), whereas clone B::3 progressively declined (5 versus 35%) and clone C::5, the most susceptible to antibiotics, spread (44 versus 2.5%). Epidemiological investigations revealed that some clones had been introduced via patients transferred from other hospitals and that cross-infection occurred within and between wards. Major changes in the use of antibiotics, especially aminoglycosides, cyclines, and macrolides, likely played a role in the emergence and spread of GS-MRSA strains.

* Corresponding author. Mailing address: Laboratoire de Bactériologie, Faculté de Médecine Pitié-Salpêtrière, 91, Blvd. de l'Hôpital, 75634 Paris Cedex 13, France. Phone: (33) 1.40.77.97.46. Fax: (33) 1.45.82.75.77. E-mail: sougakof{at}lmcp.jusssieu.fr.

Journal of Clinical Microbiology, January 1998, p. 81-85, Vol. 36, No. 1
0095-1137/98/$04.00+0
Copyright © 1998, American Society for Microbiology. All rights reserved.


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