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Journal of Clinical Microbiology, November 1999, p. 3452-3457, Vol. 37, No. 11
Centre National de Référence des
Toxémies à Staphylocoques,
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.
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

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