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Journal of Clinical Microbiology, November 1999, p. 3452-3457, Vol. 37, No. 11
0095-1137/99/$04.00+0
Copyright © 1999, American Society for Microbiology. All rights reserved.

Emergence and Spread in French Hospitals of Methicillin-Resistant Staphylococcus aureus with Increasing Susceptibility to Gentamicin and Other Antibiotics

Hervé Lelièvre,1 Gerard Lina,1 Mark E. Jones,2,dagger Claude Olive,3 Françoise Forey,1 Micheline Roussel-Delvallez,4 Marie-Hélène Nicolas-Chanoine,5 Cécile M. Bébéar,6 Vincent Jarlier,7 Antoine Andremont,8 François Vandenesch,1 and Jerome Etienne1,*

Centre National de Référence des Toxémies à Staphylocoques, EA 1655, Faculté de Médecine, 69372 Lyon Cedex 08,1 Laboratoire de Microbiologie, Hôpital Pierre Zobda Quitman, 97261 Fort de France,3 Laboratoire de Bactériologie, Hôpital Calmette, 59037 Lille Cedex,4 Laboratoire de Microbiologie, Hôpital Ambroise Paré, 92100 Boulogne,5 Laboratoire de Bactériologie, Hôpital Pellegrin, 33076 Bordeaux Cedex,6 Laboratoire de Bactériologie et Hygiène, Groupe Hospitalier Pitié Salpétrière, 75651 Paris Cedex 13,7 and Laboratoire de Bactériologie, CHU Bichat-Claude Bernard, 75877 Paris Cedex 18,8 France, and University Hospital of Utrecht, 3584CX Utrecht, The Netherlands2

Received 7 May 1999/Returned for modification 6 July 1999/Accepted 29 July 1999

Oxacillin (methicillin) resistance in methicillin-resistant Staphylococcus aureus (MRSA) is associated with an increased incidence of resistance to other antibiotics, which has increased since it was first reported in 1969. In 1992 a new phenotype of MRSA arose in France; this was characterized by a heterogeneous expression of resistance to oxacillin and susceptibility to various antibiotics, including gentamicin but also tetracycline, minocycline, lincomycin, pristinamycin, co-trimoxazole, rifampin, and fusidic acid. In French hospitals a longitudinal nationwide surveillance of antibiotic resistance in S. aureus has allowed for the detection of changes in antibiotic susceptibility profiles. Seven French clinical laboratories (six from the mainland and one from the West Indies) reported the results of susceptibility testing of 57,347 S. aureus strains isolated in their institutes between 1992 and 1998. Over a 7-year period the incidence of isolation of gentamicin-susceptible MRSA (GS-MRSA) strains has steadily increased to represent, in 1998, 46.8 to 94.4% of the MRSA strains, irrespective of the overall incidence of MRSA. Two predominant types recognized by pulsed-field gel electrophoresis (PFGE) accounted for the majority of the GS-MRSA in different mainland hospitals, both differing from the predominant type observed in the French West Indies. Some GS-MRSA and gentamicin-resistant MRSA (GR-MRSA) strains had closely related PFGE profiles, and hybridization studies confirmed the lack in GS-MRSA of the aac6'-aph2" gene, which confers resistance to all aminoglycosides, with conservation of the ant4' gene, which confers resistance to kanamycin, tobramycin, and amikacin. Thus, it is likely that certain GS-MRSA strains could have emerged from GR-MRSA strains by excision or deletion of the aac6'-aph2" gene.

* Corresponding author. Mailing address: Faculté de Médecine, Laboratoire de Bactériologie, Rue Guillaume Paradin, 69372 Lyon Cedex 08, France. Phone: 33 (0) 478 77 86 57. Fax: 33 (0) 478 77 86 58. E-mail: jetienne{at}univ-lyon1.fr.

dagger Present address: MRL Pharmaceutical Services, 3554XD, Utrecht, The Netherlands.

Journal of Clinical Microbiology, November 1999, p. 3452-3457, Vol. 37, No. 11
0095-1137/99/$04.00+0
Copyright © 1999, American Society for Microbiology. All rights reserved.


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